Providio MediSolutions provides a broad spectrum of Medicare Secondary Payer Act (MSPA) compliance solutions for law firms, defendant insurers, third party administrators, self-insureds and, of course, Medicare beneficiaries themselves. We are uniquely positioned to provide value to clients by offering a variety of tools to help navigate the uncertain waters of MSPA compliance.
Services
MSPA compliance ought to be approached through the prism of systematic rather than ad hoc behavior, especially when there is a lack of clear guidance on how to comply with all aspects of the MSPA.
In this sense, the MSPA is similar to the Foreign Corrupt Practices Act because the FCPA (1) creates a broad mandate (i.e., that multi-national corporations may not bribe or in any other way financially induce foreign officials to conduct business with them) but (2) does not specifically guide corporations on how to comply with the act. Likewise, the MSPA issues a broad mandate that Medicare shall be a secondary payer and that all primary payers must take Medicare's interest into account when settling a workers' compensation or liability case; however, there is confusion, conflicting case law and, in some areas, a complete lack of guidance in terms of how primary payers should comply with the MSPA general mandate. While CMS has issued some guidance through a series of memoranda and calls over the course of time, many issues surrounding compliance with the MSPA (particularly with respect to liability cases) remain unclear.
Accordingly, we recommend that just like corporations who devise their own compliance plans in order to adhere to the FCPA, primary payers subject to the MSPA ought to utilize a wide range of tools/services on a consistent basis and in accordance with a documented compliance plan in order to protect Medicare's interest and, thereby, protect themselves.
There are situations, however, where clients may need or want to engage limited Providio services. Consequently, our services are also available on an a la carte basis.
Our full spectrum of compliance solutions fall into several primary categories as follows:
- Compliance plan development and implementation (including training)
- Compliance plan monitoring/auditing
- Individual compliance tools:
- Conditional payments
- Medicare Set-asides
- CMS submissions
- Conditional payments - lien negotiation (government & private liens)
- MSPA continuing education for attorneys/paralegals and claims adjustors/defense counsel
- Medicare beneficiary self-administration tools
- Full-service MSA administration