The AAJ Announced CMS New MSP Guidelines

Posted date in Jason D. Lazarus, J.D., LL.M., MSCC MSP Compliance

The CEO of the AAJ, Linda Lipsen, sent out an email communication today to all AAJ members regarding new guidelines for the MSP.  The AAJ is supporting the SMART Act (HR 1063) which is legilsation designed to improve the MSP as it relates to conditional payments (HR 1063 does not deal with Medicare Set Asides). The SMART Act is currently sitting in committee but it has widespread bipartisan support. 

The contents of Linda Lipsen's email are below.

"September 20, 2011


Dear Colleagues, 

AAJ Public Affairs is working steadily on solutions to create certainty, finality and proportionality in the reimbursement process when your clients are Medicare beneficiaries.

This is a long road that started more than two years ago. Last year, the Centers for Medicare & Medicaid Services (CMS) announced a one-year delay in Medicare Secondary Payer (MSP) liability reporting requirements so that they could work on improving the process. More recently, AAJ anticipates that CMS will announce a series of policy changes that will be implemented over the coming months. These policy changes should have a positive impact on the amount of time it takes to resolve an MSP reimbursement claim as well as provide some certainty in the process.

In addition, CMS will likely issue guidance this week regarding Medicare beneficiaries with exposure or ingestion claims, in particular, claims that occurred prior to 1980. We are hopeful that this guidance will, in part, address some of the issues that many of you have had settling exposure claims involving a Medicare beneficiary. As soon as this guidance is finalized and we have a better understanding of its contents, we will let you know. As always, if there are any concerns we will address them with policy makers accordingly.

Progress is being made, and we will continue to advocate for program changes until the system is running smoothly.

Many of you know that in addition to our work with CMS, AAJ is also advocating for a bipartisan bill, H.R. 1063, the Strengthening Medicare and Repaying Taxpayer Act (SMART Act) that pushes a number of changes, including requiring CMS to provide the amount of conditional payment prior to settlement.

MSP issues are important to you and your clients and we are actively tracking this fluid situation; it has been changing week-to-week for several months. We will keep you updated as soon as we hear more.

Best Regards,

Linda Lipsen
Chief Executive Officer
American Association for Justice"

Hopefully CMS's guidelines will be of the helpful variety.  Past attempts at changes such as the recent low dollar threshold of $300.00 for conditional payments really don't do anything at all.  The Sally Stalcup memo on liability Medicare set asides on the other hand was welcome commentary by a CMS official regarding a previously undocumented policy. 

Any reform of the MSP would be welcome at this point.  We need a change to the conditional payment process.  We also need codification of Medicare set asides.  Thankfully the AAJ is pushing CMS and Congress for relief on these issues.