Change, non-change important to Medicare compliance regulations


If you have been trying to keep up with the latest Medicare compliance changes, you might feel like you are watching the carnival vendor who used to say, “around and around it goes and where it stops nobody knows.” Fortunately, with these answers you don’t have to guess.

Liability: CMS withdraws proposal for liability MSAs

Sometimes the biggest developments come from the changes that don't happen; this was the case for Medicare set-asides (MSAs) in liability cases. In 2012, the Centers for Medicare and Medicaid Services (CMS) intimated they were going to issue rules and regulations about Medicare set-asides (MSAs) in liability cases. This raised concern in the industry because the proposed rules made little sense in the context of liability cases. Sedgwick was concerned the proposed rules would unreasonably delay and drive up the costs of resolving liability cases. Last month, we, as a member of the Medicare Advocacy Recovery Coalition (MARC), met with CMS representatives to address many outstanding items related to Medicare compliance. When this issue came up, MARC asked that CMS withdraw the current proposal. We received confirmation that CMS granted the request and has, in fact, withdrawn the proposal concerning liability MSAs.

Despite the recent developments, our best practice regarding liability MSAs remains unchanged, so things are “business as usual” for Sedgwick. We believe our established approach to be reasonable based on the uncertainty involving liability MSAs.  Input from the defense attorney and the client will be necessary to determine if a liability MSA is applicable in any given case.

January 2015 change in reporting of SSNs

What might be one of the best changes to come about – and I think you will agree – is the pending change in Social Security number (SSN) reporting, as it will greatly simplify a burdensome process. CMS recently announced that, beginning Jan. 5, 2015, only the last five digits of a claimant’s SSN will be required for Medicare reporting purposes. This change reduces the burden on our claims handling teams to collect full SSNs from claimants who may not want to provide this information. We anticipate the removal of this obstacle will significantly simplify the Medicare reporting processing for our colleagues. More detail about the new rule can be found in the announcement linked above.

I think both of these changes – or, rather, one non-change and one change – are significant to how you do business. Particularly, the change on Social Security number reporting is a very positive step and one that will reduce administrative time and potential errors. We will continue to keep you updated on important changes in the Medicare compliance space. In the meantime, please feel free to contact us. Our expert team is ready to work with you.

Michael Merlino, VP, Medicare and Medicaid compliance

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