Why the Ever-Evolving Medicare Secondary Payer Landscape Requires a Diligent MSP Services Partner (Part 2)
Written by: Heather Sanderson, Esq., MSPA, MSACP
Medicare Set-Asides
When it comes to best-in-class claims handling, it is imperative that carriers and self-insureds do not pay more than what they owe for past or future benefits. Any carrier or self-insured who winds up paying more than they should to resolve a claim knows that ultimately the public suffers because this drives up insurance costs and premiums for everyone. In our experience, many in-house third-party administrator (TPA) Medicare Set-Aside (MSA) service offerings lack rigor and innovation, especially in cases that warrant “outside the box” thinking.
When settling a case in need of an MSA, it is important to receive allocations that call out opportunities for cost containment/clinical mitigation. This allows the parties time to pursue those avenues prior to settlement. Further, nearly all TPAs do not offer protection or indemnification on MSAs that are not submitted to the Centers for Medicare and Medicaid Services (CMS) for review and approval. CMS has workload review thresholds in place, so not every MSA may be submitted for review and approval – how are you protected on these cases should the TPA fail to get an allocation altogether or if they write one and the parties rely on it, but CMS disagrees with it down the line? Starting April 4, 2025, CMS will require Section 111 reporting of MSA amounts at the time a case settles with a beneficiary for more than $750! How is your TPA protecting you on your non-threshold cases in particular? At Sanderson Firm, we provide a wide variety of MSA services to ensure compliance and to help parties mitigate costs – which include but are not limited to evidence-based MSAs (eMSAs), legal compromise MSAs (LCMSAs), as well as indemnified non-submit MSAs (iMSAs). We also offer an Abbreviated MSA (aMSA) for below threshold/low-dollar settlements.
Partnership Provides Best Protection
TPAs are a great option for adjusting and handling claims. But a strong strategic MSP partner that specializes in MSP solutions elevates the insurance payer’s and self-insured employer’s experience, compliance, and cost savings, which drives long-term success. A true partner, like Sanderson Firm, delivers:
Oversight and Compliance– Sanderson Firm doesn’t process Section 111 data as “data in data out” without oversight, like many TPAs. Your MSP partner should mitigate these risks and navigate your Section 111 reporting with data oversight, especially given the immediate risk of CMPs. Written by clinical and legal experts, our MSA offerings are varied and thus tailored to the facts of each individual claim, and identify mitigation opportunities, unlike the standard TPA MSA offerings. As a law firm dedicated to MSP compliance, our MSAs receive attorney oversight and an avenue for addressing any legal questions. Your MSP partner should not provide a one-size-fits-all approach to MSAs, but rather should offer a variety of MSA solutions depending on your desired outcomes and accounting for your risk strategy and appetite.
Comprehensive Customer Service and Transparency on Results– A comprehensive MSP compliance partner thinks differently than most TPAs and provides service and support through a dedicated account team to launch the program, clinical and legal experts to strategize and educate, as well as an executive team to support client success. As a true partner, Sanderson Firm provides clients with report cards on a regular basis, highlighting time and again our unparalleled MSP program results.
Technology and Innovation– MSP requirements are constantly evolving, trends change over time, and goals shift over time too. Technology needs to keep pace and innovation needs to anticipate the future of MSP compliance. Your MSP compliance program must deliver the platforms and technology to meet your current needs and innovate to drive future compliance. Your MSP compliance partner should always be asking “What if?” and “What’s next?” Additionally, your MSP compliance partner should be able to deliver and counsel on MSP changes, regulatory updates, and respond with solutions immediately. Sanderson Firm is driven by relentless commitment to our clients’ MSP compliance needs and to innovative solutions for same.
Does your TPA just process your MSP services or are they a strategic partner helping you navigate MSP compliance? If you are not in an MSP compliance partnership with your TPA, then it is time to consider outsourcing your MSP services to an expert. Sanderson Firm is a full-service/nationwide MSP services provider of Section 111 reporting services and offers a full suite of Medicare Set-Aside products and services, as well as conditional payment identification and resolution.
This concludes Part 2 of our Medicare Set-Aside series. To learn more about how Sanderson Firm can help you strengthen your MSP compliance program, contact us today. (Click here for Part 1.)
