Existence of MSA Companies Validated by the Social Security Administration

Medicare Set-Aside Blog on November 18, 2010 | Posted by

For anyone who’s ever gone to a local Social Security Administration office to obtain entitlement information about a claimant to determine the need for MSP compliance efforts and had a career federal government employee treat you with obvious disdain for interrupting their counting the days til retirement, you will appreciate a recent addition to the Program Operations Manual System (POMS). Apparently our efforts are in furtherance of a legitimate federal cause and must be tolerated – to a limited degree. The new sections reads as follows:


GN 03316.155 Disclosures to Medicare Set-Aside Companies with Consent


A. Background


Medicare set-aside companies request Medicare and benefit entitlement information from our records to assist insurance carriers, third party administrators, self-insured companies, and attorneys in complying with Medicare Secondary Payer (MSP) laws. MSP laws protect Medicare’s interests in workers’ compensation settlement cases. Medicare set-aside companies use the information they request to help Medicare determine settlement amounts in cases involving future medical and drug-related expenses. We may only disclose information to Medicare set-aside companies with proper consent.


B. Fee charging for non-program related requests


We consider requests from Medicare set-aside companies as non-program related requests. Therefore, we must charge and collect fees prior to disclosing any information. Some companies may insist that the requested information relates to administering Medicare or workers’ compensation programs. Nonetheless, Medicare or worker’s compensation programs are third party private commercial entities, which are not directly responsible for administering health and income maintenance programs under the Social Security Act. Medicare set-aside companies act as advocates for attorneys, carriers, and claimants in coordinating workers’ compensation and Social Security, Medicare, and Medicaid benefits. As such, we must charge fees for providing the requested information.


C. Requests for queries from Medicare set-aside companies


We do not provide queries of any type, including TPQYs, for requests from Medicare set-aside companies. Medicare set-aside companies usually request limited data. We may only provide a query output if the consent document authorizing disclosure specifies every piece of information on the query.


So apparently MSP laws do only apply in workers’ compensation situations (the liability attorneys will appreciate that support for their arguments against the express inclusion of liability and no-fault in the actual MSP statute) and gaining awareness of a claimant’s dual eligibility so that notice can be provided to SSA of a WC claim to properly off-set SSDI payments is not a program related request so SSA must charge us for access to said information.  Glad we cleared that up.

The true disappointment here is that if SSA is going to all this effort to acknowledge that entitlement information must be released to MSA companies with the proper release and fee, why not clear up all those other little inconsistencies, such as how much the fee is and how many checks must we really write; can we truly only make three requests at a time without going back to take another number or can we really just leave a pile of requests to be picked up at another time; outline what information MSA companies would actually need for MSP compliance reasons since SSA employees don’t actually understand or better yet, provide a form. So many possibilities…