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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:

 
 
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.
 
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.
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.
 
You can expect the typical turn-around time of 5-6 months.
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.
 
Submission through the Portal now provides an instantaneous confirmation of receipt.
 
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.
 
The Portal allows for documents to be uploaded directly into the system, removing the potential for lost documents and the resulting delay.
 
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.
 
You can track the submission through the Portal without having to speak to anyone at CMS or the WCRC.
 
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.
 
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.
 
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.
 
CMS has created a two strike policy for submitting cases that do not meet the review thresholds.
 
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.”
 

 
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
 
 
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