CMS Hosts MSPRP Electronic Payment Enhancement Webinar

The March 13, 2019 webinar offered by CMS provided a description of the new direct payment features available through the Medicare Secondary Payer Recovery Portal (MSPRP) as of April 1, 2019.  CMS will be releasing presentation slides within five (5) to seven (7) days and will also be releasing the audio recording thereafter.  Some of the features of this direct payment option include the following:

  • Direct payments for conditional payments can only be made for claims in the demand status.
  • Parties can submit partial payment, but interest will continue to accrue on the remaining balance.
  • Forms of payment are limited to: checking or savings account, debit card, or PayPal account.
  • Amount of payment is limited to $10,000 for PayPal accounts, $24,999 for a debit card and $999,999,999 for savings and checking accounts.
  • Payments made from checking and savings accounts or a debit card will be processed through PA.Gov which is run by the Department of Treasury, while PayPal payments will run through the PayPal system and will be subject to PayPal’s privacy and security rules.
  • The date of payment for CMS purposes will be the date the electronic payment was made.
  • The parties are not precluded from mailing payments to CMS and utilizing this function is not mandatory.

NuQuest will provide updates on the additional materials to be posted by CMS when they become available.  Should you have any questions regarding the above, please do not hesitate to contact the NuQuest Settlement Consultant Team.

CMS Announces Webinars for MSPRP and CRCP Electronic Payment Options

CMS will be hosting two webinars to review the addition of a new electronic payment option that will be added to the Medicare Secondary Recovery Portal (MSPRP) and the Commercial Repayment Portal (CRCP) effective April 1, 2019.  The webinars will include opening remarks followed by a presentation on the new electronic payment functionality.

The MSPRP webinar will take place on March 13, 2019, at 1:00 P.M. ET Conference Dial-In: 877-251-0301 Conference Passcode: 7556747.  The CRCP webinar will take place the following day, on March 14, 2019, at 1:00 P.M. ET Conference Dial-In: 877-251-0301 Conference Passcode: 3436359.

NuQuest will continue to update you on these new developments as this information becomes available.

CMS Issues a Revised WCMSA Reference Guide and Section 111 User Guide

The Centers for Medicare and Medicaid Services issued a revised WCMSA Reference Guide (Reference Guide), Version 2.9, which can be found here: WCMSA Reference Guide.  In addition to changes to development and alert templates; references to removal of certain memorandum from cms.gov; and reference to the updated CDC Life Table, the Reference Guide also includes updates to Spinal Cord Stimulators (SCS), and the inclusion of Lyrica, Trazodone and other off-label drugs in an MSA.

Section 1.1 of the Reference Guide state as follows:

  • To eliminate issues around Development Letter and Alert templates auto-populating with individual Regional Office (RO) reviewer names and direct phone numbers, these will now display the generic “Workers’ Compensation Review Contractor    (WCRC)” and the WCRC customer service number “(833) 295-3773” (Appendix 5).
  • Per CMS’ request, certain references to memoranda on cms.gov have been removed.
  • The CDC Life Table has been updated for 2015 (Section 10.3).
  • Updates have been provided for spinal cord stimulators and Lyrica (Sections 9.4.5 and 9.4.6.2).

With respect to SCS, Section 9.4.5 now includes the following language:

Routine replacement of the neurostimulator pulse generator includes the lead implantation up to the number of leads related to the associated code. Revision surgeries should only be used where a historical pattern of a need to relocate leads exists…

Surgery pricing may include physician, facility, and anesthesia fees. SCS pricing is based on identification of: 1.) Rechargeable vs. Non-rechargeable and 2.) Single vs. Multiple Arrays (leads). If unknown, CMS will default to non-rechargeable single array.

This pricing methodology outlined by CMS is consistent with recent CMS approval trends.

In addition, traditionally excluded from MSAs based upon off-label usage arguments, CMS has recently included Lyrica in certain allocations.  The new Reference Guide specifically addresses off-label usage arguments with respect to Lyrica as follows:

Example 1: Lyrica (Pregabalin) is cited in MicroMedEx for an off-label medication use related to neuropathic pain from spinal cord injury, and a number of scientific studies indicate that Pregabalin shows statistically significant positive results for the treatment of radicular pain (a type of neuropathic pain). Spinal cord neuropathy includes injuries directly to the spinal cord or its supporting structures causing nerve impingement that results in neuropathic pain. Lyrica is considered acceptable for pricing as a treatment for WCMSAs that include diagnoses related to radiculopathy because radiculopathy is a type of neuropathy related to peripheral nerve impingement caused by injury to the supporting structures of the spinal cord.

The language above utilized by CMS for the inclusion of Lyrica in the MSA may be an indication of things to come not only with respect to more and more allocations including this medication, but inclusion of additional off-label medications that were previously excluded from the MSA. A second example in the Reference Guide describes circumstances in which Trazodone will be included in MSAs.

In addition to the new WCMSA Reference Guide, CMS has also issued a new Section 111 NGHP User Guide (Guide).  The updated Guide includes the confirmation that the review threshold for reporting in 2019 will remain $750 for liability insurance settlements, judgments awards or other payments and $750 for no-fault and workers’ compensation claims where there is no ongoing responsibility for medicals (ORM) that was previously posted by CMS.  The Guide can be found here – Full Guide for further review and reference.

NuQuest will continue to keep you apprised of further Medicare compliance developments as they become available.

 

CMS and Medicaid to Convert to CDC 2015 Life Table

The Centers for Medicare and Medicaid Services has announced that it will convert to the CDC’s “Table 1: Life Table for the total population: United States, 2015“ for Workers’ Compensation Medicare Set-Aside life expectancy calculations.  The change to the updated life table will become effective as of January 5, 2019.  There is a slight increase in life expectancy reflected in the new table and in some circumstances this may decrease WCMSA calculations.  All WCMSAs should reflect the updated life table changes from January 5, 2019 and ongoing.

For further information regarding this alert or any Medicare compliance needs, please contact the NuQuest Legal Team.

The OMB Issues Intent of Notice of Proposed Rule Making for Section 111 Penalties

In an abstract entitled “Civil Money Penalties and Medicare Secondary Payer Reporting Requirements,” the Office of Management and Budget has issued another intent of Notice of Proposed Rulemaking this time involving Section 111 Reporting penalties.  Specifically, the abstract of the Notice provides as follows:

Section 516 of the Medicare Access and CHIP Reauthorization Act of 2015 amended the Social Security Act (the Act) by repealing certain duplicative Medicare Secondary Payer reporting requirements. This rule would propose to remove obsolete Civil Money Penalty (CMP) regulations associated with this repeal. The rule would also propose to replace those obsolete regulations by soliciting public comment on proposed criteria and practices for which CMPs would and would not be imposed under the Act, as amended by Section 203 of the Strengthening Medicare and Repaying Taxpayers Act of 2012 (SMART Act).

Pursuant to the SMART Act, civil penalties for non-compliance with Section 111 are up to $1,000 per day, per claimant.  However, no official guidance regarding how these penalties will be determined and enforced has been issued by CMS.  Similar to the Notice issued by the OMB we reported on last week involving Liability Medicare Set-Asides, action to be taken on the Notice of Proposed Rulemaking is set to take place in September 2019.  NuQuest will continue to keep you abreast of any additional developments as they become available.  For  further questions regarding this Notice or for any of your Medicare compliance needs, please contact the NuQuest Legal Team.