The Centers for Medicare and Medicaid Services (CMS) has released a policy memorandum (dated September 29, 2011) pertaining to liability Medicare set-aside (L-MSA) arrangements. CMS has indicated the new guidelines and procedures are effective “upon publication of this memorandum” so they are already applicable, folks.
Per CMS, the memo provides information regarding proposed Liability Medicare Set-Aside Arrangement (L-MSA) amounts related to liability insurance (including self-insurance) settlements, judgments, awards, or other payments (which they note as “settlements”). Through this memo, CMS indicates they will consider Medicare’s interests regarding future medicals to be “satisfied” upon procurement of specific information from the plaintiff’s treating physician as follows:
Where the beneficiary’s treating physician certifies in writing that treatment for the alleged injury related to the liability insurance (including self-insurance) ‘settlement’ has been completed as of the date of the ‘settlement,’ and that future medical items and/or services for that injury will not be required, Medicare considers its interest, with respect to future medicals for that particular ‘settlement,’ satisfied. If the beneficiary receives additional ‘settlements’ related to the underlying injury or illness, he/she must obtain a separate physician certification for those additional ‘settlements.
If the physician certification as referenced above is obtained, according to CMS you do not need to submit the certification or any proposed L-MSA to be reviewed. In keeping with their tradition of refusing to provide any parties with significant confirmation that they have made appropriate efforts, CMS will not provide the parties with any type of confirmation indicating Medicare’s interest regarding future medicals is satisfied and instead they strongly suggest plaintiffs and/or their representative maintain the physician’s certification.
To obtain a copy of CMS’ September 29, 2011 memo, please email Shawn R Biery at firstname.lastname@example.org.
In other CMS news, you can now attempt to contact CMS to determine conditional payments if you have the necessary information and use an automated service. It appears to be working as long as you have all of the necessary info. The MSPRC phone number is the same, (866)677-7220, but now it gives you the option to use the automated service or to speak to an associate.
To use the automated service, you will need to have the following information:
- Case Identification Number (as found on the Rights and Responsibilities letter)
- Date of Loss
- Beneficiary's Date of Birth
- Last four digits of the SSN
- First four digits of beneficiary's last name
- Medicare Number
After receiving the status on a file, it will ask if you want to search for another case or speak to an associate. Remember, to speak to an associate, there will be an extended hold time (with Shawn’s personal best being over 70 minutes). For more information on the MSP automated response feature, go to www.msprc.info .
Our law partner, Shawn R. Biery, J.D. holds the M.S.S.C. certification and has presented opinions in seminars throughout the U.S. If you have had the pleasure of working with him in the past, you know that he has been advocating for obtaining confirmation of “no further treatment” from treating physicians for an extended period already. If you have questions or concerns about such issues, please feel free to contact Shawn at email@example.com.