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The Workers’ Compensation
Medicare
Set-Aside Portal:
A Ray of Hope for Improved
MSA Review Efficiency
By Steve Chapman and Gregg Chapman,
Esq.
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Steve Chapman and Gregg
Chapman, Esq. specialize in
structured settlements of workers’
compensation
cases. In this article they discuss the new Workers' Compensation
Medicare Set-Aside Portal.
For more information on structured settlements
and the structure broker’s role, see:
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A small sign of progress, just in
time for the New Year, was recently
made by CMS in regards to improving
Workers’ Compensation Medicare
Set-Aside (WCMSA) review efficiency
with the introduction of the WCMSA Portal (WCMSAP). The WCMSAP went
live on November 29, 2011. The WCMSAP is a Web-based application
that allows MSA submitters to
directly enter case information, upload
documentation, and receive case status information through the use
of a secure Web portal. While the impact the WCMSAP will have on
reducing CMS’ turnaround time
on MSA reviews is probably small,
it will improve other aspects of the review process.
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| The WCMSAP is a
Web-based application
that allows MSA submitters to directly
enter case information, upload
documentation, and receive case status information through the use
of a secure Web portal. |
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CMS
has been beta testing the Portal
over the last few months by having a
few MSA vendors make submissions
electronically. During this testing phase, CMS was expediting the
review of MSAs submitted through the
Portal. If you were lucky enough
to have a case have a MSA go through
the Portal, the review was completed
in 4-6 weeks. However, now that the Portal has been opened up to
everyone, these submissions will no longer be handled on a priority
basis and you can expect the typical
turn-around time of 5-6 months.
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You
can expect the typical turn-around
time of 5-6 months.
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The current process for submitting MSAs requires
the MSA vendor to copy the MSA
report, two years of medical reports
and two years of payment histories onto a CD-ROM and mail it to
the Coordination of Benefits Coordinator in Detroit, MI. Now that
the Portal has gone live, the MSA vendor can send the submission
via the web. Under the manual process, once the vendor mailed the
submission, they would have to wait several weeks to receive a
confirmation from CMS that the submission had been received and
entered into their system. Only upon obtaining this confirmation
could the parties rely that the
review process had started. Submission
through the Portal now provides an instantaneous confirmation of
receipt thus eliminating the delay and uncertainty.
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Submission through the Portal
now provides an instantaneous confirmation of receipt.
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The ability to upload documents
via the Portal not only improves the
efficiency of the MSA submission,
but should drastically cut down on
errors that occur when CMS requests
additional documentation. Unfortunately, it is not uncommon for CMS
to ask the MSA submitter to send more records in order for it to
complete a review. Every MSA vendor has horror stories of having
to repeatedly send the same document
three, four, or five times before
CMS finally acknowledges its receipt.
This causes additional unnecessary
delays. The Portal allows for
documents to be uploaded directly into
the system so the potential for lost documents and the resulting
delay is removed.
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The Portal allows for documents
to be uploaded directly into the system, removing the potential for
lost documents and the resulting delay.
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One of the best attributes of the
Portal is its ability to provide case status information. Up until
now, the only way to check on the progress of a MSA under review
was to call the Workers’
Compensation Review Contractor (WCRC)
or the CMS Regional Office, leave a message and wait for someone
to return the call. Through the use of the Portal, the submitter
can instantaneously track the location of the submission (at the
WCRC or the Regional Office). Additionally, the Portal will provide
information regarding where in the review process the case stands.
It will indicate if the case has been
closed due to missing documents,
if the case has been reopened, if the
case doesn’t meet review
thresholds, if the case is in
development, if the case has been approved,
etc. Once a case is approved, the submitter will receive an e-mail
and will be able to download the approval letter. This case status
function will not only keep the
parties up to date, it can be accessed
electronically without the need to speak with anyone at CMS or the
WCRC.
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You can track the submission
through
the Portal without having to speak to
anyone at CMS or the WCRC.
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CMS acknowledges that the current
turnaround time for completing MSA reviews needs to be improved and
they are hearing this from all sides.
Now that the Portal is completed
they say that reducing this delay is their number one priority. CMS
says that the number one factor
causing the backlog are MSA submissions
they receive that don’t meet the review thresholds. They say
that 33% of all submissions are under
their thresholds. With submissions
averaging more than 2000 per month, there are literally hundreds
of cases that clog up the system and create a logjam that increases
the turnaround time for reviews. The reason for so many needless
submissions is twofold. First, many
defendants request a below threshold
MSA be submitted because they either
don’t understand the guidelines
or believe they are getting some
level of extra protection by needlessly
sending it in. Secondly, MSA vendors are only too happy to comply
with these requests even though they know it is a useless exercise
because they can charge these clients a submittal fee or they want
to keep a client happy.
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CMS says that the number one
factor
causing the backlog are MSA submissions that don’t meet the
review thresholds. 33% of the
submissions are below the thresholds.
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One
way CMS is attempting to eliminate
these wasteful submissions is to punish vendors that send these in.
CMS has created a two strike policy for submitting cases that do
not meet the review thresholds. If CMS determines that a vendor has
submitted a below threshold case more than once, their access to
the Portal will be blocked and they
will only be able to submit cases
via the mail. Thus, vendors will be
highly motivated to verify Medicare
eligibility prior to submission and they will no longer submit a
case that they know is below threshold just because their client
wants them to or because they want to earn a fee.
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CMS has created a two strike
policy
for submitting cases that do not meet the review thresholds.
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The WCMSAP is a step in the right
direction to improving efficiency in
the MSA review process. However,
there is a long way to go. Both sides
to a workers’ compensation
settlement are at the mercy of CMS and must wait several months for
a decision regarding the MSA. I think it would be acceptable to all
parties if CMS would just live up to the statement it made in its
April 22, 2003 Memo: “ROs (Regional Offices) seek to review
and make a decision regarding proposed WC settlements within 45 to
60 days, from the time that all necessary/required documentation
has been submitted.”
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Steve Chapman strives to
remain current on all issues affecting
the settlement of the case, including
Medicare set-aside allocations,
life care plans, medical cost trends,
Long Term Disability, and Social
Security issues.
To contact
Steve Chapman:
Steven F. Chapman
National Settlement Consultants
12039
Jefferson Blvd.
Culver City, CA 90230
Phone: 800-845-2969
Fax:
310-450-3132
Cell: 310-480-5742
Email: SettleMan@aol.com
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Gregg Chapman has been
a member
of the State Bar of California for twenty years. Over the last
eight years, he has worked for two of the largest national MSA
vendors in various positions including General Counsel, National
Sales Manager and Director of MSA
Education. He has provided hundreds
of presentations on all topics regarding Medicare Set-Asides to
the insurance industry and attorney
associations across the country.
To contact Gregg Chapman:
Gregg Chapman
National Settlement Consultants
12039 Jefferson Blvd.
Culver City, CA 90230
Phone: 800-845-2969
Fax: 310-450-3132
Email: greggchap@aol.com
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