MSA Compliance Rules Part III
Part III of compliance rules for MSA.During our premium audits and reserve reviews, we have noticed some areas on MSA’s that were cause for concern. I thought that I would point them out as a way to avoid fines or other problems due to misreporting MSA’s.
If your carrier or TPA is properly reporting claims, you should be receiving a status report from the CMS. We have found that very often during premium and reserve reviews that no one has seen any such report, which is really an acknowledgement letter.
If you are not receiving the acknowledgement letters – (from CMS), please contact the Coordination of Benefits (COB) Contractor. Customer Service Representatives are available to provide you with quality service Monday through Friday, from 8:00 a.m. to 8:00 p.m., Eastern Time, except holidays. The COB Contractor’s toll free number is 1 (800) 999-1118 or TTY/TDD: 1 (800) 318-8782 for the hearing and speech impaired.
As pointed out in my last post, the fines are very steep for non-compliance on reporting. I do not recommend calling your TPA or carrier if you are not receiving the letters, call the CMS directly as noted. The employer has the ultimate responsibility.
Past vs. Future Medicals
One mistake we noticed is there was no differentiation between future or past medical costs and other costs on the submission or noted in the settlement. This a great example from the CMS –
A settlement that does not specifically account for past versus future medical expenses will be considered to be entirely for future medical expenses once Medicare has recovered any conditional payments it made. This means that Medicare will not pay for medical expenses that are otherwise reimbursable under Medicare and are related to the WC case, until the entire settlement is exhausted.
Example: A beneficiary is paid $50,000 by a WC carrier, and the parties to the settlement do not specify what the $50,000 is intended to pay for. If there is no CMS approved Medicare set-aside arrangement, Medicare will consider any amount remaining after recovery of its conditional payments as compensation for future medical expenses.
I wanted to cover this topic again as it is not found in any of the CMS examples. If a claim happens on US soil, the settlement is subject to the MSA rules. This has not been specifically addressed by the CMS. I do not think any employer would want to supply the test case for non-compliance in this area.
Article provided by James J Moore, AIC, MBA, ChFC, ARM. All articles are original content. Check out the full website at www.cutcompcosts.com.