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03/Oct/2024

On September 23, 2024, CMS released new announcements regarding Civil Money Penalties. This follows other recent updates and webinars from CMS that have placed additional emphasis on reporting settlement details, and an even greater preference for claimants to use professional MSA administration.

A New NGHP Webpage for Civil Money Penalties

A new webpage for NGHP Civil Money Penalties (CMP) for Section 111 Reporting is now available. Click here to view it. The new webpage is a tool for Responsible Reporting Entities (RREs) to comply with Section 111 of the Medicare, Medicaid, and SCIP Extension Act. The RREs are required to report to CMS regarding the Medicare beneficiaries including information about liability insurance (including self-insurance), no-fault insurance, and workers’ compensation claims where the injured party is a Medicare beneficiary.  The new page offers details on the CMP Final Rule, a CMP Workflow Chart, and more.

Expanding Reporting Requirements

The increased MSA mandatory reporting requirements fields enhance oversight and ensure proper coordination of benefits. Historically, CMS has had limited or incomplete information on MSAs which is why CMS has expanded the existing S111 mandatory reporting requirements. The expanded data fields will capture information on all WC claims involving Medicare beneficiaries who received a settlement.

Beginning April 4th, 2025, all workers’ compensation settlements involving Medicare beneficiaries that include a MSA of $750 or more, must be reported to CMS, even if the settlement was previously reported voluntarily or did not previously meet the CMS review threshold for MSA submission, which remains at $25,000. For further details regarding reporting requirements, please refer to the NGHP User Guide.

A Reminder of the Expanded Data Reporting Fields

    • MSA Amount
    • MSA Period (# of Years)
    • Funding Type (Lump Sum or Annuity)
    • If Structured
    • Initial Deposit Amount
    • Anniversary (Annual Deposit Amount)
    • Case Control Number
    • Professional Administrator EIN

 

What Does All of This Mean?

CMS wants to be made aware of settlement details. The new NGHP CMP webpage is the most recent example that CMS is focused on S111 reporting, non-compliance, review of records for auditing to identify non-compliance, penalty amounts of non-compliance, and the process of how non-compliance decisions will be handed down.

On September 12, 2024, CMS presented a webinar (click here to view presentation) on Section 111 NGHP Mandatory Reporting for Liability Insurance (including Self-Insurance), No-Fault Insurance and Workers’ Compensation. Additionally, a second webinar has been announced for another Medicare Secondary Payer & Civil Money Penalties webinar, scheduled for October 17, 2024, to provide a stage for any last-minute inquiries. CMS is taking every opportunity to promote its push for emphasis on receiving accurate and timely settlement information from RREs.

With the new expanded data requirements, very little will change in the way cases are handled by a professional administrator. On the other hand, claimants choosing to self-administer their MSA may find themselves exposed to greater risk of jeopardizing their Medicare benefits.

Reminder: Claimants who self-administer their MSA funds have hefty obligations so they do not jeopardize their Medicare benefits. These obligations include:

      • MSA funds held in an interest-bearing account
      • MSA funds may only be used for Medicare-covered and injury related expenses
      • Keep accurate record of expenses paid out of the MSA account
      • Coordination of health insurance benefits
      • Annual attestation reporting submitted to Medicare

     

Why Choose Medivest Asure for Professional Administration

With the additional responsibility and penalties looming overhead, doesn’t it make sense to work with an experienced Professional Administrator? Medivest was the first to professionally administer a MSA Account, and has been providing this service since 1998 – longer than any other company. Asure members have their MSA accounts managed by the Medivest team who will:

      • Ensure funds are spent down according to the allowable guidelines
      • Communicate with doctors, pharmacists, and DME suppliers for proper billing
      • Negotiate fees for medical services and future surgeries
      • Coordinate benefits with other health insurance plans including Medicare
      • Prepare required annual compliance documents for Medicare
      • Work with the medical providers and pharmacies of your choice
      • Protect Medicare entitlement by ensuring compliance with Medicare regulations

To download a Medivest Asure flyer, click here.

For Additional Information

Medivest will continue to monitor changes occurring at CMS and will keep its readers up to date when such changes are announced. For questions, feel free to reach out to the Medivest representative in your area by clicking here or call us at 855.931.3003.

 


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26/Sep/2024

Mandatory Reporting for Liability Insurance (including Self-Insurance), No-Fault Insurance and Workers’ Compensation

CMS will be hosting a webinar regarding Certain Civil Money Penalties for NGHP Responsible Reporting Entities (RREs). The format will be opening remarks and a presentation by CMS that will include reminders about the Final Rule, the auditing process and important dates, followed by a question and answer session. RREs who would like to submit questions in advance of the webinar are encouraged to do so using the dedicated resource mailbox at Sec111CMP@cms.hhs.gov.


 

Date: October 17, 2024
Time: 1:00 PM ET

Webinar Link: https://cms.zoomgov.com/j/1602011678?pwd=e54vgVqZczEGeWbDf4hk95AeozMh47.1
Passcode: 145914

Or to connect via phone:

Conference Dial In: (833) 568-8864
Conference Passcode: 160 201 1678

Important Note: This is a public webinar and there is no pre-registration needed. The webinar link should only be utilized the day of the webinar. Due to the number of expected participants, please log in at least 10 minutes prior to the start of the presentation.


 

Additional information about the most recent updates from CMS can be found here. If you have questions on how topics discussed in this webinar may affect your clients or your company, please contact Medivest or call us at 877.725.2467.


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28/Aug/2024

Mandatory Reporting for Liability Insurance (including Self-Insurance), No-Fault Insurance and Workers’ Compensation

CMS will be hosting a Section 111 NGHP Reporting webinar. The format will be opening remarks by CMS, a presentation that will include NGHP reporting best practices and reminders, followed by a question and answer session. For questions regarding Section 111 reporting, prior to the webinar, please utilize the Section 111 Resource Mailbox PL110-173SEC111-comments@cms.hhs.gov.

 


 

Date: Thursday September 12, 2024
Time: 1:00 PM ET

Webinar Link: https://cms.zoomgov.com/j/1619262037?pwd=VnY1RWFLTWc4RXN4RjZ5YzV4WDQvdz09

Passcode: 315331

  Or to connect via phone:

Webinar Dial In: 1-833-435-1820
Webinar ID: 161 926 2037


 

Additional information about the most recent updates from CMS can be found here. If you have questions on how topics discussed in this webinar may affect your clients or your company, please contact Medivest or call us at 877.725.2467.

 


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26/Aug/2024

It’s been a busy 2024 for CMS. Since February 2024, over half a dozen updates have been made to Section 111 Mandatory Insurance Reporting and CMS’s policies.  

Ultimately, these new changes increase awareness and focus on post-settlement MSA spending, emphasizing the importance of utilizing a competent professional administrator 

What this means is you need Medivest’s Asure Pro-Admin more than ever to navigate these changes and keep all settlement parties from getting penalized for non-compliance!  

Medivest’s Asure Pro-Admin Helps Protect All Parties 

 

Asure Pro-Admin:
Professional Administration for MSA Accounts by the professionals
 

  • Medivest claimant accounts saved over 70% of what they were billed by providers over the last 12 months
  • An average of 23.3% of the original MSA is disbursed to the surviving beneficiary or reversionary interest party upon the claimant’s death
  • During our 27 years of business, we have only had a 2% member cancellation rate due to unforeseen reasons other than death. This remarkable retention rate underscores the value and satisfaction our members experience with our services
  • Medivest members and clients can be confident that a Claims specialist will review every line item on every bill submitted, ensuring proper coordination of benefits

 

Self-Asure:
The DIY solution with Medivest’s expert support

  • Don’t go it alone! Use Self-Asure to navigate the CMS government maze 
  • The Self-Asure Self-Administration Kit, an innovative tool first created by Medivest, is good for injured parties with a small MSA that is designed to exhaust in a short length of time. Self-Asure provides guidance to individuals who opt to manage their own MSA, and pairs it with phone support and medical bill review from Medivest’s experienced Member Services team.  
  • However, a Self-Administration Kit still has limitations, particularly if multiple bills come in at once. So the settlement parties need to carefully consider Medivest for professional administration per CMS’s recommendation. 

 

4 Asure:
Easy approach to navigate settlement compliance for Insurer, Self-insured, and TPA without adding ANY work to the adjuster’s already full plate. The streamline process of:

  • Medicare Status check/lien investigation to determine if MSA is recommended
  • Structured Settlement consultant for rated age and MSA funding 
  • MSA Allocation Report (if needed) 
  • Professional Administration of MSA 

CONTACT MEDIVEST TODAY – WE ARE HERE TO HELP!

877-725-2467 (Monday – Friday 8am to 5pm EST)

 

Summary/Takeaways 

MMSEA Section 111 Mandatory Insurer Reporting (NGHP)

Medicare is ramping up its data collection. New fields have been added to the Section 111 Claim Input File to capture WCMSA information on all Workers’ Compensation (WC) claims involving Medicare beneficiaries.  

These data collections will have a significant impact on reporting and WCMSA compliance for the use of non-submit and Evidence Based Medicare Set-Aside arrangements. By capturing this new data, Medicare will know when funds have exhausted, make more appropriate determinations regarding the coordination of benefits, and more thoroughly investigate which injury related medical payments they should be denying. The new fields will become effective 4/4/25. 

Self-Administration Toolkit, Version 1.6 

Under the WCMSA Guidelines, CMS has the right to recovery. Over 1/3 of Medicare recipients have a Medicare Advantage Plan (MAP). These plan providers have asked for the same recovery rights that CMS has. The last sentence in Section 4.1.3 of the new Self-Administration Toolkit takes the first steps to clearly spell out that CMS is extending their rights of recovery to MAP partners: 

If you are enrolled in a Medicare Advantage or prescription drug plan, please contact your plan to discuss your WCMSA, if you have not already done so.  

WCMSA Reference Guide, Version 4.3 

In the latest update of the WCMSA reference guide, Medicare Advantage Plans continue to be spotlighted. In Section 4.1.3, CMS states: 

CMS notifies Part C and D plan sponsors that a WCMSA has been approved and instructs plan sponsors to conduct Medicare Secondary Payer (MSP) investigations. However, CMS does not relay WCMSA details to plan sponsors… The administrator must provide details concerning treatments and medications used exclusively to treat a related illness or injury to the plan sponsor so the sponsor may avoid making primary payment in the future.

CMS instructs the MAP sponsors that a WCMSA exists but doesn’t share any specific details of the MSA. It seems inevitable that this will create a communication breakdown at some point. The onus of communication is put entirely on the administrator. For a professional administrator, this will be a common (and new) task, but for someone attempting to self-administer their WCMSA, a whole new world of responsibility and questions are about to be spotlighted.

For the full information on these alerts from CMS, please visit the “What’s New” page of their website. 

For Additional Information

Medivest will continue to monitor changes occurring at CMS and will keep its readers up to date when such changes are announced. For questions, feel free to reach out to the Medivest representative in your area by clicking here or call us direct at 877.725.2467 (Monday – Friday 8am to 5pm EST).

 


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02/Aug/2024

The Centers for Medicare & Medicaid Services (CMS) released a revised Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide (“Reference Guide”) Version 4.1 on August 1, 2024. This Reference Guide replaces Version 4.0 which was released on April 1, 2024. There are a few notable changes when comparing the two Reference Guides.   

Changes in Version 4.1 of this Guide Include the Following Changes

  • By CMS’ request, the guide has been updated with details about WCMSA coordination with other health insurers (Section 4.1.3).

To download the new WCMSA Reference Guide v4.1 click here.  

This guide reflects information compiled from all WCMSA Regional Office (RO) Memoranda issued by CMS, from information provided on the CMS website, from information provided by the Workers Compensation Review Contractor (WCRC), and from the CMS WCMSA Operating Rules. The intent of this reference guide is to consolidate and supplant all historical memoranda in a single point of reference. Please discontinue the reference of prior documents.

For Additional Information

Medivest will continue to monitor changes occurring at CMS and will keep its readers up to date when such changes are announced. For questions, feel free to reach out to the Medivest representative in your area by clicking here or call us direct at 877.725.2467.

 


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02/Aug/2024

The Centers for Medicare & Medicaid Services (CMS) has released the Self-Administration Toolkit for WCMSAs version 1.6 on August 1, 2024. The Toolkit replaces Version 1.5 which was released on May 15th.

To download the new Self-Administration Toolkit for WCMSA Version 1.6 click here.

Self-Administration with Additional Help

For injured parties who are considering self-administration, but who also want additional consultation on the process, Medivest provides a Self-Administration Kit. With purchase of the Medivest Medicare Set-Aside Self-Administration Kit, the injured person will receive a one-hour consultation on the proper administration of a Medicare Set-Aside account, covering topics including:

  • Where to deposit and hold Medicare Set-aside funds
  • Which expenses are allowed to be paid from a Medicare Set-Aside account
  • What rates must be used to negotiate and pay for expenses
  • How to annually report the Medicare Set-aside to the CMS
  • What to do if the MSA funds exhaust temporarily or permanently
  • How to discuss a Medicare set-aside with a medical provider
  • What are the tax implications of interest earned on Medicare Set-Aside funds

 

For Additional Information

Medivest will continue to monitor changes occurring at CMS and will keep its readers up to date when such changes are announced. For questions about self-administration, professional administration or anything else regarding rules and recommendations from CMS, feel free to reach out to the Medivest representative in your area by clicking here or call us direct at 877.725.2467.

 


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30/Jul/2024

On July 19, 2024, the Centers for Medicare & Medicaid Services (CMS) created a new reference guide which will be referred to as, Non-Group Health Plan (NGHP) Medicare Secondary Payer (MSP) Beneficiary Reference Guide version 1.1.

The update provides details on the process of recovering conditional payments from the Medicare beneficiary, which typically involve the following steps:

  1. Reporting the case to the BCRC
  2. BCRC issues a Rights and Responsibilities letter
  3. BCRC identifies Medicare’s interim recovery amount and issues the CPL
  4. BCRC issues a Conditional Payment Notification (CPN)
  5. Dispute Process
  6. BCRC issues a recovery demand letter
  7. Assessment of Interest and Failure to Respond
  8. Referral of debt to the Department of Treasury

 

For further details on the steps of recovering conditional payments, visit CMS’ website here. To download the Non-Group Health Plan (NGHP) Medicare Secondary Payer (MSP) Beneficiary Reference Guide Version 1.1 by clicking here.

DISCLAIMER:

This guide is intended to provide Medicare beneficiaries with a reference manual to help them navigate the Medicare conditional payment recovery process. It is in no way intended as an exhaustive, step-by-step guide, nor is it intended to replace, supersede, or otherwise contradict any existing policy or procedural guidance. If anything in this manual appears to create ambiguity or to alter an existing process or obligation in any way, we recommend that the reader seek further guidance.

For Additional Information

Medivest will continue to monitor changes occurring at CMS and will keep its readers up to date when such changes are announced. For questions, feel free to reach out to the Medivest representative in your area by clicking here or call us direct at 877.725.2467.

 

 


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22/May/2024

The Centers for Medicare & Medicaid Services (CMS) has released the Self-Administration Toolkit for WCMSAs version 1.5 on May 15, 2024.  The Toolkit replaces Version 1.4 which was released on July 3, 2023.

To download the new Self-Administration Toolkit for WCMSA Version 1.5 click here.

Self-Administration With Additional Help

For injured parties who are considering self-administration, but who also want additional consultation on the process, Medivest provides a Self-Administration Kit. With purchase of the Medivest Medicare Set-Aside Self-Administration Kit, the injured person will receive a one-hour consultation on the proper administration of a Medicare Set-Aside account, covering topics including:

    • Where to deposit and hold Medicare Set-aside funds
    • Which expenses are allowed to be paid from a Medicare Set-Aside account
    • What rates must be used to negotiate and pay for expenses
    • How to annually report the Medicare Set-aside to the CMS
    • What to do if the MSA funds exhaust temporarily or permanently
    • How to discuss a Medicare set-aside with a medical provider
    • What are the tax implications of interest earned on Medicare Set-Aside funds

     

For Additional Information

Medivest will continue to monitor changes occurring at CMS and will keep its readers up to date when such changes are announced. For questions about self administration, professional administration or anything else regarding rules and recommendations from CMS, feel free to reach out to the Medivest representative in your area by clicking here or call us direct at 877.725.2467.

 


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09/Apr/2024

On April 1, 2024, Centers for Medicare & Medicaid Services (CMS) updated the MMSEA Section 111 Non-Group Health Plan (NGHP) User Guide version 7.5. It has been posted to the NGHP User Guide page on CMS.gov.  The NGHP User Guide version 7.5 replaces Version 7.4 which was released on January, 30, 2024.

To download the updated MMSEA Section 111 NGHP User Guide 7.5 click here.

MMSEA III- April 1, 2024 – NGHP User Guide Downloads 7.5

Updates:  There are no changes for this version

Updates:  There are no changes for this version.

Updates:   The submission of information related to Workers’ Compensation Medicare Set-Aside Arrangements (WCMSAs) will be required for all records submitted with a TPOC date after April 4, 2025 (Section 6.5.1.1). As of January 1, 2024, the threshold for physical trauma-based liability insurance settlements will remain at $750. CMS will maintain the $750 threshold for no-fault insurance and workers’ compensation settlements, where the no-fault insurer or workers’ compensation entity does not otherwise have ongoing responsibility for medicals (Section 6.4).

Updates:  The submission of information related to Workers’ Compensation Medicare Set-Aside Arrangements (WCMSAs) will be required for all records submitted with a TPOC date after April 4, 2025 (Sections 6.1, 6.4.4, and 6.5). As of January 1, 2024, the threshold for physical trauma-based liability insurance settlements will remain at $750. CMS will maintain the $750 threshold for no-fault insurance and workers’ compensation settlements, where the no-fault insurer or workers’ compensation entity does not otherwise have ongoing responsibility for medicals (Section 6.4).

Updates:  Beginning April 4, 2025, CMS will collect information about WCMSAs through Section 111 reporting. To support this effort, related fields have been added to the Claim Input File Detail Record; note that as the current file layout is unchanged, all the not-yet-implemented codes are marked with an asterisk (*) in the field number to distinguish them from the those in the current file layout. Once they are in effect, all the asterisks will be removed and the fields that follow them will be renumbered. Error codes related to these fields have also been added to the Claim Response File Error Code Resolution Table (Appendix A and Appendix G).

Updates:  The end-of-line character has been clarified for files using HEW software (270/271 File Translation).

For Additional Information

Medivest will continue to monitor changes occurring at CMS and will keep its readers up to date when such changes are announced. For questions, feel free to reach out to the Medivest representative in your area by clicking here or call us direct at 877.725.2467.

 


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02/Apr/2024

The Centers for Medicare & Medicaid Services (CMS) released a revised Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide (“Reference Guide”) Version 4.0 on April 1, 2024. This Reference Guide replaces Version 3.9 which was released on May 15, 2023. There are a few notable changes when comparing the two Reference Guides.   

Changes in This Version 4.0 of this Guide Include the Following Changes:

  • Instruction specific to beneficiaries has been added to encourage them to use their Medicare.gov access to the portal for the most efficient method of submitting attestations (Sections 11.1.1 and 17.5). This user-friendly mechanism which allows CMS to gain potentially more MSA spending information than it has received via traditional mailing, may lead to CMS denying more future medical claims or potentially considering whether recovery of future medical payments that slipped through the cracks is viable. 
  • The CDC Life Table link was updated (10.3) – available to view here.

 

To download the new WCMSA Reference Guide v4.0 click hereThis guide reflects information compiled from all WCMSA Regional Office (RO) Memoranda issued by CMS, from information provided on the CMS website, from information provided by the Workers Compensation Review Contractor (WCRC), and from the CMS WCMSA Operating Rules. The intent of this reference guide is to consolidate and supplant all historical memoranda in a single point of reference. Please discontinue the reference of prior documents.

For Additional Information

Medivest will continue to monitor changes occurring at CMS and will keep its readers up to date when such changes are announced. For questions, feel free to reach out to the Medivest representative in your area by clicking here or call us direct at 877.725.2467.

 


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