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Medicare set-asides getting faster approvals with new contractors


DANA POINT, Calif. — Medicare set-aside accounts for workers compensation settlements have been receiving faster approvals in recent months since the Centers for Medicare and Medicaid Services switched contractors for the review process, a group of Medicare experts said Thursday.

The challenges of Medicare secondary payer compliance were the focus of a panel this week at the California Workers' Compensation & Risk Conference in Dana Point, Calif.

Panelists discussed government approvals for Medicare set-asides, which are funds used in workers comp settlements to pay future medical costs for Medicare-eligible workers. The optional approval process is conducted by a contractor, and Medicare experts have said it can take several months to receive approvals for set-asides.

However, Michelle Allan, an attorney with law firm Burns White L.L.C. in Pittsburgh, said Thursday that her firm has seen faster results with Provider Resources Inc., the Erie, Pa.-based contractor that began reviewing Medicare set-aside agreements in July. Approvals previously were handled by Annapolis Junction, Md.-based contractor Lifecare Management Partners L.L.C.

"We've been seeing turnaround times in under three months, two months in some cases," Ms. Allan said. "So it seems as though they're doing a pretty good job in trying to be timely and keeping things moving.”

Jennifer Jordan, general counsel with Medicare compliance company Medval L.L.C., estimated that there is a backlog of about 8,000 of Medicare secondary-payer cases that accumulated before Provider Resources took over this summer. She said it appears the new contractor is working to narrow down the accumulated cases.


"We have received two approvals out of our 200 cases pending in the backlog, and one was from November and one was from March," Ms. Jordan said. "So there's no rhyme or reason for what order they're attacking it."

Despite seeing a quicker approval process, Provider Resources appears to be going through a "learning curve" as a new Medicare contractor, said Daniel Anders, compliance director for MedAllocators Inc., a Medicare compliance firm in Lawrenceville, Ga. He said some Medicare set-aside reviews received by MedAllocators have had errors.

“I assume after a while, after they get though the bugs and the mistakes, that it will level off in terms of the errors we're seeing in the MSA approval letters we're getting back,” Mr. Anders said.

The Medicare panel was moderated by Mark Walls, vp-claims at Safety National Casualty Corp. in St. Louis. Panelists also included Kimberly Wiswell, managing director for Medicare set-aside services with Irvine, Calif.-based CompPartners Inc., and Russell Whittle, senior staff counsel and vp of Medicare secondary payer compliance for consultant Gould & Lamb L.L.C. in Bradenton, Fla.