Have you had a call like this?

Medicare Set-Aside Blog on October 20, 2010 | Posted by

“Ryan, Thought you might be interested in a story related to our discussion yesterday…

I received  another call today from a beneficiary who had a 1998 WC claim.  Claim was submitted for back pain but turns out he apparently had kidney disease and an aneurysm.  We received no medicals, made no payments for medicals. 

Anyway, claimant has recently been hospitalized with heart stent, low blood sugar and COPD complications.  He is also on dialysis.  It appears someone had access to the WCC database during the admission process and she determined he had an open 10/2003 WC claim.  Therefore, she automatically determined Medicare was secondary and which created some uncertainty with the family.

Neither our records nor WCC records show an 2003 claim, just our 1998 claim.  So I am not sure exactly what the social worker was looking at but….
After many phone calls, the family has determined Medicare recognizes primary responsibility.  Unfortunately, there was a lot of confusion and angst over the last month and I see more of this coming once mandatory reporting takes full effect”

MEDVAL Comment: This is going to be a HUGE problem for current and former WC and liability claimants. Although my hope is that by providing correct ICD-9 reporting CMS will be able to distinguish between related and unrelated medical conditions. Right now, claimants caught in this bureaucratic quagmire have little in the way of support. The claims are long since closed, the attorneys are probably not involved and the claimants are ill equipped to deal with the MSPRC.

I think it might be helpful to put an FAQ guide out for providers that explains the attendant issues. Do I have any volunteers for a bi-partisan, industry derived solution?