Tower MSA Partners' Rita Wilson Predicts CMS Re-Review Changes Will Help Payers

Delray Beach, FL (WorkersCompensation.com) - Tower MSA Partners’ CEO Rita Wilson examined trends in Medicare Secondary Payer compliance during a recent “State of MSP” webinar presented by theNational Alliance of Medicare Set-Asides Professionals (NAMSAP).

“The biggest impact on payers will come from changes to the Centers of Medicare and Medicaid Services’ re-review process for otherwise approved workers’ compensation Medicare Set-Aside Arrangement (WCMSA) amounts,” Wilson predicted. 

Currently, MSA providers can influence a counter-higher decision only by providing evidence of changes in medical or pharmaceutical care that occurred before CMS submission. On December 21, 2016, CMS announced plans to update its re-review process in 2017 to address cases where CMS has approved a WCMSA amount, then medical care changed “substantially” after submission, and settlement has not occurred. 

“CMS will need to establish the parameters for re-review and define ‘substantial changes.’  We expect costly procedures such as surgeries and spinal cord stimulators to be included,” Wilson said. “A WCMSA involving patients who have weaned off expensive polypharmacy regimens could also qualify.”

 “Tower’s workflow and decision-tree software application identifies recommended, not-yet-performed procedures and intervenes to address inappropriate treatment prior to submitting an MSA,” Wilson said, “But this could be a game-changer for payers with CMS-approved MSAs that they were unable to settle.” 

Nuquest’s Rasa Fumagalli and Ciara Koba with Burns White co-presented the January 25 webinar, which recapped major MSP events of 2016, including aggressive Part C conditional payment recovery efforts. A recording of the webinar is available for an $86 fee at https://namsap.site-ym.com/store/ViewProduct.aspx?id=8294316.

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