MSP Compliance Blog

Attendees of Tower’s Premier Webinar on April 20 received sound advice on how to work with Medicare Part C (Advantage) and D (Drug Benefits) plans. Our guest presenter was Brian Bargender, Consultant, Subrogation and Third-Party Liability with Humana, a nationally recognized expert on these plans.

Bargender noted that these plans have the same rights and responsibilities as original Medicare under the Medicare Secondary Payer (MSP) Act. This means that Part C and D plans must avoid payment for treatment covered by primary payers, such as workers’ compensation or liability. Part C plans take this commitment seriously as they want to prove they are more efficient than original Medicare.

The PAID Act gave primary payers visibility into Medicare beneficiary enrollment status in Parts C and D. Previously, they could only see that an individual was enrolled in Medicare. It was problematic to identify a beneficiary’s plan and resolve conditional payments. The growing popularity of Medicare Advantage plans was making the process more time consuming. Approximately 46% of Medicare beneficiaries use Part C and 75% of the ones on original Medicare have Part D.

Bargender explained the plans’ approach to MSP compliance and touched on Private Cause of Action and Double Damages in the MSP Act. Medicare Advantage plans can obtain double damages from primary payers that refuse to reimburse conditional payments. And primary payers remain liable for repayment until plans are repaid, even if they have already paid the injured worker their settlement.

To make it easier to work with Part C and D plans in light of the PAID Act, Bargender offered these insights and advice:

• While Section 111 reporting gives primary payers “an” address, it’s not necessarily the address the plan would have chosen. As such, further investigation into the appropriate plan contact may be necessary.
• Medicare Advantage plans get Section 111 data, but not always in time to act on it. They use it as a back sweep to see if they missed anything.
• Contact the plans before trying their recovery vendors; they have multiple vendors.
• Ask for the subrogation or legal departments. Customer service reps at C and D plans are not well versed in Medicare Set-Asides.
• It’s hard for Medicare Advantage and drug plans to predict and staff for call volume; prepare for delays.
• The plan may not have the file when payers contact them.
• It’s good for primary payers to notify the plan(s) when they accept responsibility for the claim, and certainly when they prepare for settlement. The Centers for Medicare and Medicaid Services (CMS) notifies plans later in the process.
• To minimize calls and delays, provide plans the same information given to CMS for Ongoing Responsibility for Medical (ORM) or Total Payment Obligation to Claimant (TPOC) reporting along with the MSA diagnosis and prescription drug details if they are available.
• At minimum, plans need this data:
  • Medicare Beneficiary Identifier
  • Name
  • Date of birth
  • Loss/Injury Date
• Part C and D plans cannot correct errors in the file; these must be done through Section 111 reporting or through the Benefits Coordination and Recovery Center (BCRC).
• These plans do not track how funds are used or exhausted. They need a letter from CMS to the MSA administrator or beneficiary that says funds were properly exhausted before they can start paying for injury care.

Tower has found Bargender and Humana’s subrogation team to be very helpful. They promptly identify specific reimbursement claim information when the claimant is enrolled in a Humana Medicare Advantage plan. Further, they are open to understanding the liability issues and basis for settlement; this is something not typically found with the Medicare conditional payment recovery contractors.

As Bargender stressed, “proactive beats reactive,” when it comes to resolution of these Part C and D claims. Primary payers must be proactive in using PAID Act data to identify whether a Medicare eligible claimant is enrolled in a MA plan, and, if so, investigate whether the plan is seeking reimbursement for payments it made on the claim.

For our Section 111 reporting clients, Tower has the PAID Act data readily available. Whether you are a reporting or non-reporting client, we can help you contact the Part C and/or D plan to investigate and resolve conditional payments at the time of settlement.

If you have questions or want a link to the recorded webinar, please contact Dan Anders at Daniel.anders@towermsa.com

Related articles

The PAID Act: Implementation and Implications for Claims Handling

Independent Audit Verifies Tower MSA Partners’ Internal Controls and Processes

Delray Beach, FL – Tower MSA Partners, a Medicare Secondary Payer compliance services company, today announced that it has completed its annual SOC 2 Type II audit, performed by KirkpatrickPrice. This attestation provides evidence that Tower has a strong commitment to security and to delivering high-quality services to its clients by demonstrating that they have the necessary internal controls and processes in place.

A SOC 2 audit provides an independent, third-party validation that a service organization’s information security practices meet industry standards stipulated by the AICPA. During the audit, a service organization’s non-financial reporting controls as they relate to security, availability, processing integrity, confidentiality, and privacy of a system are reviewed, examined and reported on. The SOC 2 report delivered by KirkpatrickPrice verifies the suitability of the design and operating effectiveness of Tower MSA Partners’s controls to consistently meet the standards for these criteria throughout the full audit period.

“The SOC 2 audit is based on the Trust Services Criteria,” said Joseph Kirkpatrick, President of KirkpatrickPrice. “Tower delivers trust-based services to their clients, and by communicating the results of this audit, their clients can be assured of their reliance on Tower’s controls.”

“It’s an honor to again earn an unqualified 2022 SOC 2 Type II outcome” said Wilson. “It’s an attestation that Tower’s systems, policies and procedures meet the trust services criteria of security, availability, processing integrity, confidentiality, and privacy.”

What does this mean for you?

1. Peace of mind.
   If you partner with Tower, you can be assured that
   • Our human processes and our highly automated system– have been validated by third-party auditors after a stringent analysis.
   • Your data is transferred safely, used appropriately, stored securely, and is accessible for the required amount of time.
   • You can partner with a best-in-class MSP services provider and superior technology.
2. Cybersecurity assurance. Auditors recognized Tower’s commitment to keep up with cyber threats, patching, monitoring methods and cybersecurity technology. They saw that we monitor all internal systems for patching cadence and antivirus/antimalware activity, we regularly train staff on how to avoid the latest scams, and we execute multi-factor authentication and password changes to prevent breaches. In addition, we partner with reliable and well-respected cloud storage, monitoring, and security companies.

While the complete report is confidential and proprietary, a redacted synopsis of the report, SOC 3, can be downloaded here. I’m happy to answer questions and discuss the value of partnering with Tower for your MSP compliance and MSA needs. Please contact me at Rita.Wilson@TowerMSA.com to arrange for a conversation.

As an industry, we must all work to eliminate worker fatalities through an ongoing commitment to safety. April 28 is Worker Memorial Day, a time to memorialize those who died on the job.

Every year, April 28 is earmarked as Workers Memorial Day, a global day to remember and memorialize workers who lost their lives on the job. The day has several purposes:  Through a series of national and local events, it offers a way to call attention to the number of worker fatalities, to put a face on the workers who died, and to highlight the impact these deaths have on their families, co-workers, and communities. The day also sheds light on the fact that most workplace incidents are preventable and serves as a reminder for employers and workers alike to recommit to the important work of building safer workplaces.

April 28 is a fitting day for this event because it is also the day OSHA was established in 1971. Under the Occupational Safety and Health Act of 1970, “employers are responsible for providing safe and healthful workplaces for their workers. OSHA’s role is to ensure these conditions for America’s working men and women by setting and enforcing standards, and providing training, education and assistance.” OSHA’s mission encompasses 130 million workers, employed at more than 8 million worksites around the nation.

Of the 2022 Memorial, OSHA says:

“This year, we also recognize that, more than a year into the pandemic, every day essential workers, many of whom are people of color and immigrants, have put their lives on the line during the COVID-19 pandemic. Many were sickened or died as a result of just going to work – for simply doing what they had to do to support their families. They were healthcare workers, grocery workers, meatpackers, nurses, delivery drivers, farmworkers, law enforcement officers, teachers, and sanitation workers. We remember and honor every worker who has lost their life to largely preventable fatal injuries and illnesses, and we commit ourselves to fighting to make sure that others do not suffer the same terrible fate.”

The impact of OSHA on worker fatalities can be seen in the statistics:  Worker deaths in America dropped from about 38 worker deaths a day or 13,900+ per year in 1970 to 15 a day or 5,300+ per year in 2019.

The most recent Census of Fatal Occupational Injuries was issued by the Bureau of Labor Statistics in December 2021 and noted a significant decrease in worker fatalities. The report noted that there were 4,764 fatal work injuries recorded in the United States in 2020, a 10.7-percent decrease from 5,333 in 2019 and the lowest annual number since 2013. The fatal work injury rate was 3.4 fatalities per 100,000 full-time equivalent (FTE) workers, down from 3.5 per 100,000 FTE in 2019. A worker died every 111 minutes from a work-related injury in 2020.

But the number of fatalities for 2020 needs to be put in the context of the pandemic, when many workplaces were shuttered for varying lengths of time. Some safety and health experts warn that we are likely to see an increase in the numbers going forward: Serious Work Injuries and Fatalities Spike as Labor Shortages Exacerbate the Problem

“ Fewer workers died or suffered severe injuries in the workplace in 2020.

However, the rate of serious injuries and fatalities rose from 366 per 100,000 workers in 2019 to 429 per 100,000 workers in 2020, according to risk management software firm ISN.

The rate was 406 per 100,000 in 2018.

The problem could worsen as companies around the U.S. contend with a shortage of labor, which can translate into longer hours on the job by less-experienced workers, as well as a greater reliance on outside contractors.”

Working to reduce worker injuries and deaths is the right thing to do. It’s also usually the least costly thing to do and the smart thing for employers to do. Workers are concerned about workplace safety and appreciate employers who demonstrate a commitment. A recent survey showed that:

Almost all (97%) respondents said feeling safe is a major factor in choosing where to work. Asked how they would respond if their employer failed to communicate effectively about an emergency or other potentially dangerous event, 44% said they would feel unsafe and 58% said they would reconsider working there or seek employment elsewhere.

For more information on Workers Memorial Day:

• OSHA: Worker Memorial Day Events
• NIOSH:  Workers Memorial Day
• National Safety Council: Remember Those We’ve Lost, Pledge to Work Safely
• AFL-CIO:  Workers Memorial Day events

Previously on Tower MSA Partners

• Build a Better Tower: Partnerships Speed Settlements of Workers’ Comp Claims with Medicare Set-Asides
• Tower CEO Rita Wilson Talks MSAs and Metrics in WorkCompWire’s Leaders Speak

In December 2021, the Centers for Medicare and Medicaid Services (CMS) started providing access to data showing a claimant’s enrollment in Medicare Part C and D plans. Now payers are wondering how to best interact with Medicare Advantage (MA) plans and prescription drug plans. What are their reimbursement rights? How does this work with Section 111 reporting?

Tower is pleased to feature a guest presentation by Brian Bargender, Management Consultant, Subrogation and Other Payer Liability for Humana on Wednesday, April 20 at 2:00 PM ET.  Brian is arguably the industry’s foremost expert on Part C and D plan subrogation. Humana is the second-largest Medicare Advantage Plan and Part D plan in the country and has been the leading advocate for reimbursement under the MSP Act.

Here’s just some of what you will learn:

• Role of Part C and D plans in providing services to Medicare beneficiaries.
• Reimbursement rights of Part C and D plans under the Medicare Secondary Payer (MSP) Act.
• Interplay between CMS and Part C and D plans in use of Section 111 Mandatory Insurer Reporting data.
• Part C and D plans role in Workers’ Compensation MSAs.
• Best practices for working with Part C and D plans to resolve reimbursement claims.

A Q&A session will follow the presentation, and you can provide questions at the time you register. Please click the link below and register today!

REGISTER HERE

On April 13, 2022, at 1:00 pm ET, the Centers for Medicare and Medicaid Services (CMS) will host a webinar on the “Go Paperless” option in the Medicare Secondary Payer Recovery Portal.  The selection of this option will provide for more expeditious receipt of correspondence from the CMS Medicare conditional payment recovery contractors.  Per the announcement:

The Centers for Medicare & Medicaid Services (CMS) will be hosting an overview of the new “Go Paperless” feature available in the Medicare Secondary Payer Recovery Portal (MSPRP). Insurers and authorized agents may now choose to opt-in to paperless functionality. Once registered, users will be able to quickly and easily access all recovery correspondence including demand letters, using the MSPRP. Opting to “Go Paperless” in combination with the ability to submit correspondence through the MSPRP and the multiple available options for electronic payment will allow your organization to not only reduce the amount of paper that needs to be physically handled, associated workload and environmental impacts, but also eliminate concerns about delays that can arise when information is sent through the mail.

The webinar will feature opening remarks and a presentation, followed by a question-and-answer session.

Note, there is no pre-registration, instead, just follow the provided link shortly before the webinar start time.

By way of background, in January CMS released an updated Section 111 User Guide, Version 6.7, which in Chapter V provides as follows:

When there is an active Medicare Secondary Payer Recovery Portal (MSPRP) account for the insurer/recovery agent TIN, Section 111 submitters may set Go Paperless options (i.e., choose to receive letters electronically or by mail) for the insurer and recovery agent address using the following new TIN Reference File fields (Appendix B):

• TIN/Office Code Paperless Indicator (Field 23)
• Recovery Agent Paperless Indicator (Field 24)
• Recovery Agent TIN (Field 25

Note: There are also five new fields (Fields 48-52) returned for these entries on the TIN
Reference Response File (Appendix D).

Along with the updates to the Section 111 User Guide, CMS also updated the Medicare Secondary Payer Recovery Portal (MSPRP) User Manual, Version 5.3, to incorporate functionality around the Go Paperless option.

Key Takeaways

We are pleased to see CMS provide this Go Paperless option for Responsible Reporting Entities (RREs) and their authorized agents. It is environmentally friendly and will allow time-sensitive correspondence i.e., Conditional Payment Notice with a 30-day due date, to be received and acted upon sooner.

If you are interested in taking advantage of the Go Paperless option or have other questions we encourage you to attend the CMS webinar.  Also, you can always contact Dan Anders, Chief Compliance Officer, at 888.331.4941 or daniel.anders@towermsa.com with any questions.