Top 10 MSP-Related Events of 2011 – Number 4

Medicare Set-Aside Blog on January 10, 2012 | Posted by


MSP Compliance Insurance Hits the Market




Given that we are working within the risk management industry, it has been incredibly surprising that we have not seen more insurance solutions enter the MSP marketplace over the years. As big a disaster as the Coventry guaranteed MSA program turned out to be, the concept was headed in the right direction. Although all the issues not very well thought out, or that marketing and sales took precedence over legal, the core of the idea was still to insure the approval so that claims could be closed faster, thus ending the associated expenses of waiting for CMS. The problem there was in the unknown: the subjective and fluid nature of CMS’ idea of what it takes to protect Medicare’s interests. The review not being regulated made that proposition much riskier than the premiums inferred and hence the failure of the program. While there is one other plan that insured against the $1,000 per claim per day penalty for reporting noncompliance, a new policy that became available on 2011 is offering coverage for more of a comprehensive MSP compliance plan. Premiums are derived by the overall compliance plan and the number of reportable claims. Those with comprehensive and reliable reporting, conditional payment and MSA controls in place will pay significantly less in total premium, much like an employer’s premium is affected by its experience rating. The policy covers not just the reporting penalty but things like medical benefits for the claimant while MSP triggered disputes are resolved with CMS. I would anticipate this offering to become more popular in 2012 as people become more aware of the benefits of foregoing CMS approval and taking more control over of their MSP exposures.