A Busy Week for Medicare Secondary Payer: LMSA/NFMSAs Provider Notice Rescinded; New Contract Award for Commercial Repayment Center
Heather Sanderson
October 6, 2017
Liability Medicare Set-Asides (LMSAs) and No-Fault Medicare Set-Asides (NFMSAs) Update – The Centers for Medicare and Medicaid Services (CMS) has been taking incremental steps recently to implement a review process for LMSAs and NFMSAs. Over the past year we saw a series of indications that CMS was looking to implement a review process.  The Request for Proposal (RFP) for the Workers’ Compensation Review Contractor (WCRC) stated that it would possibly require the new contractor to manage a voluntary review process for LMSAs and NFMSAs potentially as early as July 1, 2018. In addition, we saw CMS take steps with medical providers to coordinate benefits for LMSAs and NFMSAs through provider notices and adding fields to the Common Working File (CWF) as of October 1, 2017 which would notate an LMSA/NFMSA amounts. For our prior blog on this topic, click here.
On September 19, 2017, CMS issued a MedLearn article to medical providers which stated that if a Medicare beneficiary alerts the provider that it has a WCMSA, LMSA or NFMSA, that the provider was to bill the MSA and not Medicare. However, the MedLearn article was confusing at best in that it elaborated that no processes or requirements were currently in place for CMS to review an LMSA or NFMSA. Unfortunately, the MedLearn article only seemed to cause confusion for primary payers and attorneys, and further there was serious concern that the guidance provided could cause benefits interruption for Medicare beneficiaries.  Franco Signor is a steering committee member of the Medicare Advocacy Recovery Coalition (MARC) and Roy Franco (a founding member of MARC) worked with that group to establish a meeting with CMS to discuss the LMSA/NFMSA issue.  Shortly after the meeting, CMS rescinded the MedLearn article. We applaud this action by CMS and expect that the stakeholder community, particularly the members of MARC, will have the opportunity to engage with CMS in a collaborative manner if and when the times comes for the implementation of a voluntary LMSA/NFMSA review process.   
Commercial Repayment Center (CRC) Contract Awarded to Performant- CGI Federal will continue as the CRC contractor through January 8, 2018. Performant Financial Company has been awarded the contract to continue the work for the CRC. CGI has been handling Non-Group Health Plan (NGHP) recoveries at the CRC since October 2015 and no reason was given for changing contractors.  With Performant’s deep experience as a Recovery Audit Contractor, our suspicion is that Performant will increase conditional payment recoveries effort and improve the accuracy of these recoveries going forward. We will continue to provide updates as they arise on this newly awarded contractor.