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August 2017 Newsletter
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Presidents Letter

Shawn Deane, Esq.
Vice President, Product Development
Dear NAMSAP Members: 

Everyone involved with Medicare Secondary Payer (MSP) compliance is lucky to be a part of an incredibly dynamic industry affecting many different stakeholders. MSP is constantly evolving and with that NAMSAP, for over twelve years now, has been there as the industry’s only non-profit organization dedicated to helping through education, outreach and advocacy. Moreover, NAMSAP has always made it a point to build a sense of community amongst its membership and to offer valuable resources. With that NAMSAP has taken it to the next level in 2017 by partnering with Truven to offer RED BOOK® at special discounted pricing for our members. For more information about signing up for RED BOOK® click here. In addition, we’ve revamped our MSCC certification course materials and will be offering a full certification course in the next 30 days.

We are quickly approaching our annual meeting and educational conference – dubbed Policy Palooza – which will be held in Baltimore on September 27th-29th. The Board and Annual Committee are working hard to finalize what looks to be a fantastic agenda packed full of valuable sessions.

If you haven’t already registered for the conference, I would encourage you to do so soon. Register at the link here and to find more information. I’d like to also send a special thanks to all of our conference sponsors and corporate partners – we couldn’t do this without your support! For more information on how to sign up for a corporate sponsorship and all of the benefits that go along with it, please click here.
As I indicated above, the MSP is constantly changing – and with that – I am pleased to announce our next NAMSAP webinar, which will focus on the new WCMSA Amended Review Process. The webinar will be August 22nd and will be presented by Robert Sagrillo of NuQuest and Sid Wong of ISO Claims Partners.
For information on the upcoming webinar please click here.

I look forward to seeing everyone at the conference in Baltimore!


In this edition of NAMSAP Advisor, we're featuring excellent articles from 3 NAMSAP members who are experts in the arena of MSP compliance. The first article, contributed by Dan Anders, Esq. of Tower MSA Partners, highlights the importance of consistent, accurate ICD10 reporting when ORM is accepted, when updates occur to accepted body parts, and when claims are settled (TPOC), as being paramount to mitigating exposure with Conditional Payments. Within the MSP industry, we’ve begun to use the term ‘alignment of MSP processes’ to describe the continuum of data transfer throughout the MSP reporting, recovery and MSA review process. Dan’s article provides an excellent foundation to understand this alignment and how it impacts Medicare’s view of conditional payments. Dan will also be part of the panel of experts who will explore this topic at NAMSAP’s Annual Conference in September.

Our 2nd article was prepared exclusively for NAMSAP Advisor by Kevin Puckett, President of KP Underwriting. KP Underwriting, LLC provides rated to Annuity and Life Insurance companies, Worker’s Compensation companies, Medicare Set-Aside Markets and Life Care Planners. KP also provides professional medical record review and underwriting for rated age and life expectancies. As a NAMSAP Gold Partner and this year’s Annual Conference Mobile App Sponsor, we commend KP Underwriting, LLC for its longtime support of NAMSAP, and thank Kevin for contributing to NAMSAP Advisor’s mission to educate, collaborate and advocate on behalf of our membership.

The 3rd article features a new author to NAMSAP Advisor, but a longtime NAMSAP member, Lavonya Chapman, RN, Esq., of Optum. Lavonya’s experience and knowledge of the MSP from the perspective of clinical, claims, legal and compliance, has allowed her to leverage her combined expertise to tackle some of the most difficult challenges in the area of Medicare recovery and outcome optimization. Her article, ‘Conditional Payment Recovery is Not for Wimps’, provides an excellent overview of the struggles faced by payers and the step by step process necessary to move the pendulum ahead when challenging Medicare’s demands.

There is a wealth of knowledge and expertise among the membership of NAMSAP, and this edition of NAMSAP Advisor is but a small slice of the total pie of experiences our organization seeks to share. We trust you will learn from the articles, and that it will spark further interest to join these and other experts in Baltimore on September 27-29 to collaborate with the top minds in our industry.




Daniel M. Anders, Edq., MSCC

Chief Compliance Officer
Tower MSA Partners, LLC

While the Commercial Repayment Center (CRC) has faced some valid criticism over the course of the past year and half in relation to its recovery efforts on behalf of the Centers for Medicare and Medicaid Services’ (CMS), not all problems start with the CRC. CRC’s recovery efforts are driven by the data employers, carriers and self-insured entities report to Medicare through the Section 111 Mandatory Insurer Reporting process. Chief among the data elements reported is acceptance of Ongoing Responsibility for Medicals (ORM) and the termination thereof. If this data is reported inaccurately or there is a failure to report required data, then the applicable plan may be faced with inappropriate recovery demands by the CRC.


Applicable Plan Reporting of ORM is the Catalyst for CRC Recovery Efforts

Since October 5, 2015, the CRC has had responsibility for the recovery of conditional payments where the insurer or employer (including self-insured entities) is the identified debtor, known in CMS terms as the “applicable plan.” The CRC learns of opportunities to recover either through 
(Click here to read the entire article)

Impact Of Long Term Opioid Use On Rated Ages And Life Expectancy

Kevin Puckett

President of KP Underwriting, LLC


With the ongoing and increasing problem of long term use, dependence and abuse of opioids, we are faced with the question of, “What is the impact of long term opioid use on life expectancy”. In the Medical Underwriting industry, this is the most common question we face, along with how does it affect a rated age. This article will discuss the process of producing a rated age, along with the challenges faced in determining the impact of long term opioid use.

A Rated Age is an age given based on an individual’s medical impairments and the effect they have on their life expectancy. In preparing a rated age, the claimant’s medical information is reviewed to determine (Click here to read the entire article)

Conditional Payment Recovery is not for Wimps

Lavonya Chapman, Esq, RN, CMSP
Medicare Secondary Payer Compliance Counsel
Settlement Solutions

Workers’ compensation, auto personal injury protection (PIP) insurers, commercial premises med pay insurers and all liability insurers continue to struggle with the recovery compliance process concerning the repayment to Medicare conditional payments CMS believes are owed as demanded.

The dispute process and challenge to the indebtedness is complex and must include supporting documents such as (Click here to read the entire article)


Committee Reports

  • Communications Committee is working on getting the word out or the Annual Educational Conference with eblasts, and posting on social media.
  • Data and Development Committee continues to struggle receiving data to track. They want to ensure everyone that there is no identifying information on the form, and it is perfectly safe to give us the case information that you can share.
  • Webinar Committee has scheduled a webinar for August 22nd titled The WCMSA Amended Review Process: What We Know, What We Don’t Know, and How to Use it Successfully. Look for information soon.
  • Annual Meeting Committee is in full preparation for the MSA Policy Palooza, in Baltimore, MD. They have lined up a great selection of speakers, and there is still time to register to attend. The Webinar Committee has added an event in August, and is lining up speakers. Look for information soon.
  • Evidence Based Medicine Committee is busy assisting with bringing in speakers for the Annual Educational Committee

In This Issue
 From the President

Accuracy in Section 111 Reporting

Impact Of Long Term Opioid Use On Rated Ages And Life Expectancy

Conditional Payment Recovery is not for Wimps

Committee Reports











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