Update on Medicare Set-aside Approvals
Saturday, October 22, 2005 | 0
In a continuing effort to help keep you up-to-date on happenings in Medicare, Gould & Lamb, LLC, a medical-financial services company, offers the following summary of some important and timely information related to Medicare set-asides:
Improvements in Medicare Approval Process Turn-Around Times
In June of this year Gould & Lamb published TAT information for the WCMSA Program implemented by CMS (Centers for Medicare and Medicaid Services) in January 2002. Since this update, we have seen additional improvements in the overall TAT from CMS.
A 10/1/05 audit of Gould & Lamb MSAs (Medicare Set-Asides) submitted to CMS for review and approval since 4/1/05 revealed an average CMS turn-around time (TAT) of just 78 days nationally.
Individual Office information is as follows:
| Atlanta | 80 days |
| Boston | 87 days |
| Chicago | 84 days |
| Dallas | 87 days |
| Denver | 72 days |
| Kansas City | 86 days |
| New York | 104 days |
| Philadelphia | 63 days |
| San Francisco | 67 days |
| Seattle | 54 days |
Please note: Those above statistics are actual audited results for cases handles by Gould & Lamb only and do not reflect the general industry trend.
This is empirical evidence of CMS improvement in reviewing and approving MSAs, however, it must be tempered with the realization that MSA vendors must do their part by producing reports that are accurate and complete. As recently as September 2005, at the 91st Annual IAIABC Conference, CMS officials reported an 80% rejection rate of the files sent to the COBC on initial submission. This rejection rate is caused by MSA vendors not providing accurate and adequate documentation, such as, medical records, claims payment, and settlement documents. A rejection at any stage of the approval process extends the TAT and adds significant cost to the open claim.
It is speculated that the proliferation of new MSA companies coupled with the absence of corporately mandated vendor panels by insurance carriers has exacerbated CMS rejection rates. Medicare has delivered on its commitment to improve approval timeframes. However, the industry must adopt aggressive internal policies if it is to realize the full benefit of Medicares efforts. Carriers should select a short list of experienced vendors (3-4) to serve their needs nationally, communicate the vendor selection to their staff, and require the vendor to provide an accurate accounting of its performance to realize the full benefit of Medicares efforts.
Net Result: CMS has made good progress in identifying problem areas in the review and approval of MSAs for qualified claimants and in taking aggressive steps to cure them. CMS TAT has made dramatic improvements. However, vendor inadequacies contribute to the misconception of extended CMS TATs.
If you have any questions concerning the information contained in this bulletin or would like source and/or reference material please contact us at news@gouldandlamb.com or call 866-672-3453 ext.1332.
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