A significant update on Medicare Set Aside (MSA) administration was shared at this year’s educational conference for the National Alliance of Medicare Set Aside Professionals (NAMSAP). John Albert, Senior Technical Advisor, Division of Medicare Secondary Payer Operations Office of Financial Management, for the Centers for Medicare & Medicaid Services (CMS), informed the audience that as soon as next month [October 2019], CMS may be allowing for electronic submission by way of the portal for annual attestations for MSA administration.
By way of background, attestation is required annual reporting to CMS accounting for and documenting the prior year’s administration and spend of an MSA account. This attestation is verification to CMS that the funds were properly expended on Medicare-covered items and services related to the underlying injury for which the MSA was established. It also alerts CMS to instances where the MSA has temporarily or permanently exhausted to ensure proper coordination of benefits – i.e. when Medicare should or shouldn’t be stepping in to pay. As CMS indicated, “[a]ttestation is highly important to ensure claims are paid properly after exhaustion.” See Self-Admin Toolkit, Sec. 8. “If Medicare is satisfied that the right amount of money has been spent appropriately, Medicare will pay for future treatments for this work injury.” Id.
Submitting accurate attestations to Medicare is extremely important in the MSA administration process as it avoids the potential for Medicare denying treatment. If an annual attestation reflects funds remaining in the account, Medicare will deny coverage for any treatment related to the injury. If no submission occurs, it is possible that Medicare could then be inappropriately paying for items or services which should have been paid from the MSA, resulting in a cost-shift to Medicare. This scenario could also result in Medicare denying treatment at some point in time.
Currently, the only way to send in attestations has been to transmit them via fax or mail to the Benefits Coordination and Recovery Center (BCRC). Mail and faxing is obviously an antiquated and imprecise process for transmitting MSA administration information. Moreover, possessing detailed treatment data in hard copy form makes data entry, analysis and tracking incredibly difficult for CMS.
Presently, submission is only mandated once per year. The only instance where submission may currently be required more frequently is in the case of an exhaustion event in between points in annual submission. However, electronic reporting would allow for a potential increase in the submission frequency of the attestation. Theoretically, submission could occur on a quarterly, monthly or even daily schedule.
Why Does Electronic Submission & Increased Transmission Frequency Matter?
These potential changes are critical steps forward for CMS and all stakeholders involved in the MSA and settlement process that are trying to properly take Medicare’s interest into consideration for the following reasons:
- Proper Coordination of Benefits. Proper, timely and accurate attestation submissions ensure that Medicare will be available to pay when necessary and that there is no disruption in benefits to the injured individual. Utilizing an electronic method, coupled with the potential ability to submit on a more frequent basis, will provide Medicare with a much more coordinated ability to determine primary or secondary payer status during the administration of an MSA. The more frequent the submission schedule, the greater the ability Medicare will have to effectuate this determination and the better off the injured party would be to ensure near to real-time coordination. Treatment and spend can drastically change within a year’s time and a more frequent reporting schedule would provide additional safeguards to everyone involved to ensure that MSA spend and coordination of benefits are in sync and that funds are being appropriately utilized per MSA guidelines.
- Convenience. It will greatly simplify the submission through a more efficient, convenient, secure and verifiable process for both individual and professionally administered MSAs. As a collateral benefit, this will also likely encourage submission.
- Actionable Data. It will be easier for CMS to ingest, process, analyze, verify and track the data contained in an electronic submission versus hard-copy form. CMS will possess robust data around actual treatment, utilization and spend. This will in turn allow CMS to utilize this in an actionable way to make better informed policy around MSA allocation methodology.
- Tracking & Forecasting. CMS would possess the data to more efficiently and effectively track actual savings to the MSA program. They will be able to see more clearly every dollar spent from the MSA account that would have otherwise been billed to Medicare. In addition, it will allow them to forecast future financial exposure to the Medicare Trust Fund from individuals that may be on a path to exhausting faster than expected and who will need to turn to Medicare for coverage.
We commend CMS for these possible enhancements. It evidences that Medicare is continuing to pay more attention to, and placing a greater emphasis on, oversight of post-settlement MSA administration to ensure that Medicare remains the secondary payer.
We will be waiting with anticipation to learn more about any new potential enhancements or changes to MSA administration reporting and will keep our stakeholders informed of any updates.