Medicare Compliance Spooktacular

In this Halloween edition of our NuQuest blog we highlight some of the tricks and treats that have been passed down to us by CMS in 2019. 


LMSAs/No-Fault MSAs

Proposed Rulemaking for LMSA/No-Fault cases was originally set to be released in September 2019.  This was then pushed back to October 2019.  Although the month/year is not over, it is anticipated that we will not see this rule come to fruition in 2019. 

Off-Label Drug Usage/Opioids

Although technically CMS started to include off-label drugs in WCMSAs in 2018, we are still seeing the effects of this in 2019.  Drug pricing continues to be the main cost driver in WCMSAs.  CMS has made great strides in the fight to combat opioid abuse and addiction.  However, these efforts have not translated down to WCMSAs as opioids are still being priced based upon the claimant’ life expectancy. 


MSPRP Enhancements

The Medicare Secondary Payer Recovery Portal (MSPRP) has been enhanced to allow for the creation of an Open Debt Report for insurance debtor cases.  MSPRP Account Managers will be able to request this report on demand through the MSPRP to view those outstanding conditional payment debts.  The information on claims in demand status will be updated nightly.  Although this is an extremely helpful tool for primary payers to identify those liens that are due and owing, it is still important to be diligent to obtain lien information before any interest or penalties can accrue.  Addition information on how to create an Open Debt Report is available in the new October MSPRP User Guide which can be found here

Attestation Enhancements

WCMSA Electronic Attestation Enhancements allow for a more efficient way to provide these statements to CMS electronically.  As we previously noted in our prior blog CMS will be hosting two webinars on this enhancement.  The first webinar will take place on October 30. 2019 and is directed to Medicare beneficiaries and their representatives.  The second webinar will be directed to professional administrators and will be held on November 6, 2019.

Smell My Feet

Section 111 Reporting Penalties

This is neither a trick nor a treat but is more akin to the suspect piece of candy you find in your bag that looks like it has been opened and then put back together again.  You know that if you ingest this, it could cause potential harm.  A $1,000 a day per/per claim also cannot be swallowed or digested easily and may definitely cause harm.  Although penalties have been talked about in the past, it appears the proposed rulemaking on this issue will be coming out this month or shortly thereafter.  As per our prior blog, it is as the final stages of dissemination.  We will continue to monitor these developments as they become available.

Should you have any questions regarding the above or need further information on any of you Medicare compliance needs, please contact us.