Top 5 Blogs from 2020

CMS, Compliance, Mandatory Insurer Reporting, Medicare Set-Aside Blog, MSP News on January 14, 2021
Posted by Shannon Flynn

While 2020 was a challenging year, we took a look back in search of our best blogs with a goal of sharing highlights with our readers. From new legislation and case law to potential reporting penalties, our blogs covered a wide range of Medicare Secondary Payer related news. Some offered insight into possibilities and trends while others featured precedents and changing rules and procedures.

We invite you to explore highlights from our top blogs of 2020:

1. New MSP Law Alert: The PAID Act

On 12/11/2020, President Trump signed into law H.R. 8900. Tucked away within H.R. 8900, was Title III – Offsets, creating transparency in Medicare Secondary Payer (MSP) reporting. Long-sought after, and lobbied for, the new law improves upon a problem that has been a sore spot in MSP compliance, by providing NGHP RREs with information to identify any applicable private insurer sponsored Medicare Advantage (MAP, also known as Part C) or Prescription Drug (Part D) plans, which may have provided benefits to injured Medicare beneficiaries who also have workers’ compensation or other personal injury claims.

During 2021, Responsible Reporting Entities must stay the course and continue to persist in their attempts to collect Part C/D plan information. But thanks to the PAID Act, on or after 12/11/2021, the same information will be readily available through their Section 111 query process.

Read the full blog to discover the impact the PAID Act may have on you.

2. Eleventh Circuit Extends the Scope: Who Else is Entitled to Double Damages Under the MSP?

On September 4, 2020 a decision out of the U.S. Circuit Court of Appeals for the Eleventh Circuit extended the scope of who may bring a private cause of action under the Medicare Secondary Payer Act and may therefore be entitled to double damages.  The case, MSP Recovery Claims, Series LLC v. Ace American Insurance Company, et. al., involved several claims allegedly assigned to MSP Recovery Claims, Series LLC (“MSP Recovery”) from downstream entities.

Very simply this case stands for the premise that the list of those who may sue primary payers for double damages has been extended.  Primary payers and any entity/individual with some sort of a nexus to a claim should not assume that they are insulated from the private cause of action provision under the MSP depending upon the entity pursuing reimbursement. 

Read the full blog to examine the facts of the case and review our takeaways and commentary.

3. Proposed Civil Money Penalties Rule for Medicare Reporting to be Released

The potential for the Centers for Medicare & Medicaid (CMS) imposing Civil Money Penalties (CMPs) against Responsible Reporting Entities (RRE) for not meeting their Mandatory Insurer Reporting obligations has existed since the Strengthening Medicare and Repaying Taxpayers Act (SMART Act) of 2012. However, CMPs have not been levied against an RRE because there has been no issued guidance surrounding assessment of CMPs.

To address this issue, on February 18, 2020 CMS published a proposed rule specifying how and when CMS must calculate and impose civil money penalties (CMPs) when group health plan (GHP) and non-group health plan (NGHP) responsible reporting entities (RREs) fail to meet their Medicare Secondary Payer (MSP) reporting obligations.

Read the full blog to explore our breakdown of the key elements of the proposed rule.

4. Workers’ Compensation Board Says “No” to Medicare Hold Harmless Language in Settlement Agreements

On March 2, the New York State Workers’ Compensation Board issued a bulletin that announced that the Board would no longer approve Section 32 Waiver Agreements that required the claimant to indemnify and hold the Carrier harmless for any payment made by Medicare for treatment of claimant’s work-related injuries before the execution of the Agreement. 

While this announcement should not impact settlement practices involving Medicare beneficiaries, it is nonetheless a good reminder of the importance of identifying and implementing proper internal protocols and best practices to address conditional payments in a timely manner. 

Read the full blog to get tips on implementing proactive best practices.

5. 04/01 Revised CMS Release Must be Used; Electronic Signatures: OK

On April 1, 2020 the Centers for Medicare & Medicaid Services (CMS) stopped accepting standard CMS releases for Workers’ Compensation Medicare Set-Aside (WCMSA) submissions.  

As indicated in the updated WCMSA Reference Guide, starting on April 1, 2020, all forms must include language indicating that the beneficiary reviewed the WCMSA submission package and understands the WCMSA intent, submission process, and associated WCMSA administration. The section of the consent form, referencing understanding of the WCMSA, must include at least the beneficiary’s initials to indicate their validation. Fortunately, CMS indicated they will accept electronic signatures that meet the requirements of the E-SIGN Act.  

Read the full blog to learn more about the specific language and requirements.

2020 was an interesting and challenging year, and we look forward to discovering what 2021 will bring.