Social Security Administration Field Offices Are Closing; Do You Have a Compliance Game Plan?

Compliance, Medicare Set-Aside Blog, MSP News, Social Security on March 20, 2020
Posted by Jean S. Goldstein, JD, CMSP

Earlier this week, in an effort to help reduce the exposure of outside activities for our at-risk population, the Social Security Administration (SSA) announced that local offices are now closed to the public for in-person service.  The press release can be found here.  Local offices will continue to provide critical services over the phone.  In addition, several offices have completely closed and will not be providing services until further notice.  Up to date information about the specific office closures can be found here, and this site is updated every 10 minutes.  However, many services provided by the Social Security Administration are readily available online.

How Will This Impact Your Claims?

Social Security Benefit Verifications are often obtained to determine benefit status, and in particular, whether a Claimant has applied for Social Security Disability benefits or a claimant’s Medicare coverage status. Because these types of verifications are not considered critical services, they will not be processed by offices at this time.  

While Closures Are Unavoidable, MSP Compliance Remains Achievable

Although we can expect additional closures, delays, and other unforeseen challenges, stay the course in your Medicare Secondary Payer (MSP) compliance efforts. Preparedness is key.  With this in mind, we offer the following 3 tips:

  1. Create an open dialogue now between the parties to coordinate and identify benefit status.  Moving forward determining benefit status through a Social Security Benefit Verification will not be possible until further notice.  For this reason, open communication with opposing counsel or a pro se beneficiary is more important than ever before.  Ask whether the injured party is a Medicare beneficiary and whether they have applied for, or are receiving Social Security Disability benefits. If so, request copies of documentation to verify benefit status.
  2. Conduct Medicare queries through Section 111 reporting to identify Medicare beneficiaries. This method of identifying current Medicare beneficiaries remains available to all responsible reporting entities; and
  3. Continue to address all areas of MSP compliance, which includes Section 111 Reporting, Conditional Payments, and Consideration of Future Medical Treatment/Costs.  As many of us have seen, telehealth and other expanded coverage options during this critical time may lend themselves to future Medicare conditional payments being made on claims involving a primary payer. We expect to see many conditional payment challenges and issues in the future.  The careful review, negotiation, and resolution of payments made will be important.  Additionally both the CommercialRepayment Center and Benefits Coordination and Recovery Center are still processing conditional payments and therefore, should not be overlooked or go unaddressed in order to avoid unintended penalties and interest.

Having a game plan and implementing the above tips will make some of the unforeseeable challenges easier to maneuver.  Our MSP Compliance team is available to assist parties in creating an MSP Compliance Plan in light of the current circumstances.  In addition, we will continue to monitor the impact of the Coronavirus on claims and will update our readers. 

Please be sure to keep checking our blog, or please feel free to reach out to a member of our team either at info@medval.com, or (410) 740-3084 to address any questions or concerns.