CMS seeks comment from industry professionals on options being considered for beneficiaries and their representatives to clarify how they can meet their obligations to protect Medicare’s interest in MSP Workers’ Comp or Liability claims. Comments must be submitted to CMS no later than 5 p.m. on August 14.
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NuQuest/Bridge Pointe (NQBP) and myMatrixx have teamed up to maximize MSA savings potential and minimize the risk of prolonged settlement negotiations!
This comprehensive solution identifies and optimizes opportunities to lower costs associated with both medical treatment and pharmacy utilization. The Pre-MSA with Drug Regimen Review (PMDR) combines a medical analysis and Drug Regimen Review to provide a unique and complete clinical evaluation of future injury-related drug and medical costs allowing you to control utilization and costs prior to CMS submission.
Since MSA guidelines, issued in June, 2009, indicated that CMS would independently price future prescription drug costs in Medicare Set-Asides (MSAs)— pharmacy utilization costs have increased significantly causing MSA settlement amounts to double or even triple— making it increasingly difficult to settle claims.
To minimize the risk of prolonged settlement negotiations and expedite case closures— while mitigating costs— NuQuest/Bridge Pointe has developed a unique approach which allows insurers to gain control of injury-related drug utilization, medical treatment and other high costs associated with a MSA— early in the process.
NuQuest/Bridge Pointe’s PMDR has realized a proven average savings of 72%— comprised of 84% savings in prescription drugs and 16% savings in medical treatment.
On April 3, 2012, Government Accountability Office (GAO) released a report – “Medicare Secondary Payer – Additional Steps are Needed to Improve Program Effectiveness for Non-Group Health Plans” – reflecting challenges, workloads, average MSA amounts approved, and more. The full report is available here.
A reminder regarding the proper address for submitting annual accounting documentation to CMS’ Medicare Secondary Payer Recovery Contractor (MSPRC).
Please send your completed annual Workers’ Compensation Medicare Set-aside Arrangement (WCMSA) Account Expenditure accounting documentation to the CMS lead Medicare Contractor at the address below:
MSPRC – Non-Group Health Plan (NGHP)
P.O. Box 138832
Oklahoma City, OK 73113
The MSPRC has implemented a new fixed percentage recovery option that will be available to certain beneficiaries effective November 7, 2011.
The “Fixed Percentage Option” gives beneficiaries who have physical trauma based Liability insurance (including self-insurance) settlements of $5,000 or less the ability to resolve Medicare’s recovery claim by paying Medicare 25% of the total liability insurance settlement instead of using the current recovery process.
Information, instructions and model language are listed in the Medicare Beneficiary & Attorney tool kit sections of the MSPRC’s website. Links to this information are provided below.
Link for beneficiary: http://www.msprc.info/index.cfm?content=includes/toolkits/beneficiary_nghp
Link for attorney: http://www.msprc.info/index.cfm?content=includes/toolkits/attorney_nghp