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Upcoming MSA Crisis Or Should I Say Past?


The Upcoming MSA Crisis

Is an MSA crisis upcoming? I am not a Medicare Set Aside Agreement (MSA) expert. Few people are overall. The one concern I have is that I do not think all participants are compliant with the reporting requirements of the MSA.

Graphic Of Big Paper Boat With Man Inside MSA Crisis On Ocean
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The Centers for Medicaid/Medicare (CMS) had delayed the upload of the claims data for months on end. I am under the impression they were also not ready for the task at hand. Handling that much data all at once equals crashed servers. It is the same as trying to access a very popular news article. The servers could never handle that much info.

My main point here is the deadline for reporting Workers Compensation claims that fall under the guidelines (see my last post) must have been reported by 1/1/11. The fine for not reporting is $1,000 per incident. The CMS memo is in my next post.

If one looks at the CMS MSA website, there is a complete website for the reporting requirements. I used to be a computer systems engineer many years ago. One of the most arduous tasks was converting data for another party to use. The normal rejection rate for a first-pass upload is approximately 10%.

Businessman With And Umbrella MSA Crisis Wind Blowing

The other side of the coin is what companies are required to upload data. My understanding is any type of property and casualty claim, which encompasses Workers Compensation.

I am wondering about:

  • TPA’s – is it the responsibility of the TPA’s or the employer?
  • Onshore Captives
  • Offshore Captives
  • Risk Retention Groups
  • Holding Companies
  • PEO’s

I could list many more. The bottom line is that someone has to upload the data. My question is who has the final responsibility even if you have a regular insurance carrier? From what I have read, it is the employer’s ultimate responsibility regardless.

How does an employer know the data that was uploaded is accurate? What if not all claims are uploaded to the CMS as required? I could go on and on with questions.

I will not geek out and get into the data structures. The best thing to remember (in my opinion) is you need to have a good consultant supervise all of the data uploads to CMS.

If anyone reading this has questions, please feel free to email me at [email protected] or call me at (800) 813-1386.

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James J Moore - Workers Comp Expert

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Management Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications


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