a single settlement, judgment, award or other payment.
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Danvers, Massachusetts (PRWEB) January 13, 2009
Background on the MSP, MIR, MMSEA & Section 111 Challenge
In December of 2007, President Bush signed into law the Medicare, Medicaid and SCHIP Extension Act of 2007 ("MMSEA"). Section 111 of the Act, the most recent in a long series of amendments to the Medicare statute known collectively as the Medicare Secondary Payer Act ("MSP"), will impact every settlement that involves an insurance carrier and Medicare-eligible claimant/plaintiff in the nation.
Specifically referred to as the "Mandatory Insurer Reporting" requirements ("MIR") and designed with the ultimate underlying goal of improving overall enforcement under the MSP, Section 111 broadly regulates insurance carriers and group health plans to facilitate Medicare's management of those instances in which Medicare should not be a primary payer. Section 111 is intended to prolong the viability of the Medicare program, estimated to be out of funds in 2018, by aggressively pursuing those instances in which Medicare should not be a primary payer.
By July 1, 2009, all Responsible Reporting Entities ("RRE"), "liability insurance and self-insurance, no-fault insurance, and workers' compensation laws and plans," will be required to begin active reporting to CMS. Under Section 111, any time a claim is filed "the plan" will need to determine whether the claimant is eligible for Medicare. When the plan encounters a claimant who is so entitled, the plan must "report the identity of such claimant and provide such other information as the Secretary may require." As CMS has revealed, the other information equates to more than 100 distinct fields of data. Reporting will be ongoing, on a quarterly basis, for no-fault insurance and non-contested workers' compensation claims, and on a "one-time" basis for all contested cases in which there is "a single settlement, judgment, award or other payment." Failure to report carries a $1,000.00 per diem, per beneficiary civil penalty.
The MSP Navigator Solution
Crowe Paradis Services Corporation ("CPSC") is proud to announce its complete, "user-friendly", Software as a Service ("SaaS") solution to the CMS 2009 MIR requirements. The MSP Navigator is a fully-outsourced, turnkey solution that harnesses the combined expertise of two industry leading organizations in the property and casualty insurance industry: Millbrook's (http://www.millbrookinc.com) data mining and business intelligence software solutions and CPSC's (http://www.CPSCmsa.com) command of the Medicare Secondary Payer Statute ("MSP")
To date, the marketplace has provided a few outsource solutions that amount to mere reporting conduits. The engine within the MSP Navigator has driven successful data projects for the property and casualty industry for more than a decade. While the MIR reporting requirements are new, the challenges of extracting meaningful data from claims handling software are not a new 2009 phenomenon. The MSP Navigator process follows best practices as defined by the overall Business Intelligence (BI) community in general and in lessons learned and refined from over 2 dozen enterprise-wide implementations in the property & casualty insurance industry.
As various claims organizations and self-insured entities grapple with the meaning of RRE status, the MSP Navigator will prove to be a unique business intelligence and compliance tool. Some of the difficulties that it can address include:
- Reporting on MIR-required data that is not found in distinct, searchable fields in claims systems
- Drawing legacy claims systems within one organization or several claims from several claims organizations together into one repository and one reporting process
- Determining Medicare eligibility status on claimants in an efficient, large scale manner
- Providing visibility on the status of CMS reporting
- Outsourcing execution reporting and consequent interaction with CMS, COB, and MSPRC in order to minimize the impact to claims personnel
- Discovering, verifying and negotiating conditional liens associated with your organization
- Providing consistent reporting to CMS, even among the non-workers' compensation parts of a claims organization that lack experience with the MSP statute.
The MSP Navigator represents a simple process driven by complex technology. It manages the entire MIR process for your organization. Highlights of MSP Navigator processes include:
- Extracting all new and modified claims data on a daily basis while offline and extracted directly from your claims systems
- Determining MIR cases, MSA recommended cases, and Conditional Payment recommended claims
- Providing a full array of status reports on our secure site
- Rectifying all reporting errors during data extraction or reporting
- Employing an alert mechanism to ensure CMS has processed reported claims
- Notifying the adjuster of MSA production, MSPRC lien negotiation, and other aspects of MSP compliance and offering an automated referral process
- Clueing the adjuster into settlement opportunities through automated, predictive analytics
Compliance with Section 111 will require multi-disciplinary expertise on complex data collection challenges as well as expertise on the complexities of MSP statute itself. The MSP Navigator is a blend of software and personnel uniquely poised to deliver the highest degree of compliance with the MIR and cost mitigation of the MSP along with the ease and certitude of a true turnkey, outsourcing solution.
For inquires, please contact Robert Lewis at (609) 410-3310.