Medicare is preparing for LMSAs. Are you ready?
Liability Medicare Set Aside. If you don’t know what an “LMSA” is yet, you’ll need to learn fast. On February 3, 2017, the Centers for Medicare and Medicaid Services (CMS) published Change Request 9893. It establishes new processes for LMSAs and No-Fault MSAs (“NFMSAs”) effective October 2, 2017.
CR 9893 is directed to Medicare Administrative Contractors (“MACs”) who coordinate payments for medical bills. The directive is designed to teach those MACs to deny payment where it should be made from an MSA. Specifically, it states that diagnosis codes associated with the open Liability Medicare Set Aside (LMSA) or No-Fault Medicare Set-Asides (NFMSA) should be denied by Medicare.
If you feel like this is Step 2 to a process that lacks its Step 1 – you’re not alone. CMS has not provided a formal review process to approve LMSAs. This Step 2 indicates the missing Step 1, a formal LMSA review and approval process is coming soon. Notwithstanding the lack of a formal process, attorneys remain liable for Medicare Secondary Payer (“MSP”) compliance.
What does this mean?
First, Medicare is preparing a process to deny claims where an LMSA exists. If the claim is denied by Medicare and no MSA exists your clients will have to pay for that care out of pocket.
Second, Medicare must be creating a process to review and approve LMSAs (and NFMSAs). We already knew Medicare wanted to create that process. Its most recent Workers Compensation MSA contract solicitation included instructions that the bidders should explain how it would create such a process.
Or, more concisely, it’s time to consider LMSAs.
Many plaintiff attorneys voluntarily hand the reigns over to defense when it comes to Medicare Set-Asides. You don’t have to give up that control. Instead, you can focus on protecting the client as that responsibility always rests with you.
Med Lien Solutions will resolve the confusion so you don’t have to deal with this. We have updated our processes for a seamless transition to provide Liability Medicare Set-Asides. Let the experts at Med Lien Solutions take the proper actions to protect Medicare, your client and you.
Contact us at (844) MED LIEN or (844) 633-5436.
Ryan Weiner
Chief Operating Officer
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