CMS Primary Plan Audits Expected in 2013
John Williams
October 26, 2012

In an effort to keep you up to date about new MSP developments I have attached an internally prepared summary document (The Role of the Recovery Audit Contractor) on a contract that was awarded on 6/20/12 to the Medicare Secondary Payer Recovery Audit Contractor (MSPRAC), the name of which has been withheld, see attached document “RAC Contract Redacted.pdf”.  You can see the origin of this CMS plan within the CMS Draft Statement of Work for Medicare Secondary Integrated Payer Contractor – 09.2011.

It appears that CMS is finally gearing up to start primary plan audits for MSP and MIR compliance as early as next year, as noted in the Office of the Inspector General (OIG) Fiscal Year 2013 Work Plan (released in October).  Most interesting may be the ability of the MSPRAC to recover not only for traditional FFS Medicare Programs (Part A & B), but also Part C and Part D plans, see the Avandia decision from the 3rd Circuit Court here.

The details and scope of the new MSP contractor program are fairly robust with 3 additional contracts already awarded between April and October of this year for other MSP recovery and coordination.

 

  1. Medicare Secondary Payer Integrated Contractor – MSPIC – StrategicHealthCare Solutions awarded 4/27/12.
  2. Business Programs Operations Contractor – BPOC – IntegriGuard, LLC awarded 9/27/12 and valued at $298MM.
  3. Medicare Secondary Payer Systems Contractor – MSPSC – ViPs now General Dynamics Information Technology awarded 6/12/12 .

 

This is consistent with the plan laid out by CMS and it looks like the “Super-Recovery” Contractor is coming together next year.  The monetary value of these contracts is extraordinary compared to historical MSP contracts.  We know that the current GHI contract for the COBC and MSPRC ended in September of 2012 and was extended for just 6 months through February of 2013 for transition to the new program.  This contract (GHI) is expected to sunset with this new and expanded program up and running next year.  The new structure is expected to improve CMS technology systems, expand COBC and MSPRC capabilities through additional funding, integrate and facilitate communications between CMS, OIG, and the contractors, and allow for audit of primary plan compliance.

Clearly the message is that primary plans need to have their houses in order with MIR and MSP Compliance in the very near term.  MSP Recovery efforts are focused on conditional payments and fines/penalties, not allocations, which have been the traditional industry focus for tracking and oversight.  Is the industry prepared for external audits of MIR data accuracy and timeliness as well as unpaid conditional payments (Part A, B, C, and D) that are found as a result?  Keep in mind, everyone who signed up as an RRE agreed to be subject to a CMS audit at some point in the future.

I hope this information is new and helpful to you.  I am happy to answer questions as they arise and explain the details of the additional contracts and CMS Plans as desired.  I will continue to update you as we learn more about the plans of the MSPRAC and the other contractors.  Franco Signor has conducted MSP/MIR audits for clients that can assist in identifying gaps in your existing MIR and MSP program.  Please let me know where we can be helpful.  Thank you.

 

 

John M. Williams

Franco Signor

Chief Executive Officer

716-877-4677 x 107 (Office)

john.williams@francosignor.com