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CMS Approves Significant Amount of Backlogged MSAs

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The industry has been notified that CMS has reviewed and processed a significant amount of backlogged Workers' Compensation Medicare Set-Asides (WCMSAs).  The following e-mail appears to have been sent by CMS today to several submitters of WCMSAs:

Subject: Workers' Compensation Medicare Set-aside (WCMSA) cases have been approved

The attached list of Workers’ Compensation Medicare Set-aside (WCMSA) cases have been approved. At this time, we are unable to post the standard notification alert on the WCMSA Portal.  Please log into the web site https://www.com/cm/hs.gov/WCMSA on or about December 21, 2012 to review the alert and associated details.

In the interim, a copy of the Centers for Medicare & Medicaid Services’ approval letter has been mailed to your office.

*****PLEASE DO NOT REPLY TO THIS E-MAIL*****

As the industry is well aware, when Provider Resources, Inc. took over review and approval of MSAs on July 2, 2012, it inherited a significant number of cases that were pending review from the previous vendor.

The turnaround time for cases submitted prior to Provider Resources’ takeover was significantly longer than those submitted on or after July 3, 2012.  On recent submissions, the turnaround time has been approximately 40 days or less.  For WCMSAs submitted prior to July 3, 2012, the turnaround time was becoming as long as ten months on average. It appeared that Provider Resources was reviewing and providing determinations on cases submitted after its takeover, but the industry could not get a straight answer from CMS on when pre-July 2, 2012 cases would be approved.

Although we are not certain what prompted CMS to address and process this large amount of WCMSAs, one can speculate that there was a great deal of pressure upon Provider Resources to complete their review of these WCMSAs so settlements could be completed prior to the end of the year.

This action by Provider Resources as well as the improved turnaround time on recently submitted WCMSAs is certainly applauded by the industry and hopefully boding well for a more reasonable, quicker and streamlined WCMSA process in 2013.   

About the Author

Heather Schwartz, Esq., MSCC, CHPE, CLMP, CMSP

Heather Schwartz, Esq., MSCC, CHPE, CLMP, CMSP

Heather is Corporate Counsel for PMSI Settlement Solutions, an industry leading provider of Medicare-Set Aside Allocations. Heather’s primary responsibility is the education and assistance of compliance with the Medicare Secondary Payer Act. She has lectured on this topic to the workers’ compensation and liability insurance and legal communities at conferences, associations, and individual offices nationwide. 

Heather is a major contributor to PMSI’s MedicareInsights blog, and also has published numerous publications on court decisions and legislative reforms involving Medicare Set-Asides, conditional payments, and Mandatory Insurer Reporting issues. Understanding that compliance with the Medicare Secondary Payer Act can be at times complex and frustrating for those that handle claims with Medicare beneficiaries, Heather’s goal is to speak and write with the primary goal being simple and understandable solutions to compliance.

PMSI’s Blog can be found at: www.medicareinsights.com
PMSI’s Knowledge Center can be found at: www.pmsionline.com/knowledge-center

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