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NAMSAP January 2019 Newsletter
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NAMSAP Quarterly Newsletter

Volume 12, Number 1 | January 2019

IN THIS ISSUE:
•  Letter from NAMSAP President
•  Webinars Highlights
•  MSCC Pre-Certification
•  Committee Highlight
•  Subscription Services
•  Strategic Goals


01 | LETTER FROM THE NAMSAP PRESIDENT

By: Amy E. Bilton, MSCC, CMSP-F
Attorney at Law
Nyhan Bambrick Kinzie & Lowry

 

Dear NAMSAP Members: 

As I sit within the four walls of my office here in cold, snowy Chicago, with the memories from the holidays slowly fading from my memory, back in the day-to-day grind, I cannot help but be thankful for the progress we have made and experiences I have shared with so many of you in NAMSAP over the last year. I am also hopeful that we will continue to make more progress and memories in 2019. 

 

I am greatly honored to have been elected President this year, which are big shoes to fill.  In looking back at the NAMSAP Presidents I have had the honor of knowing, and the breadth of knowledge and accomplishment they have brought to this organization, the New Year sparks thankfulness for the friendships I have made and the shining examples I have been provided.

 

I am sad knowing I will not have bi-weekly calls with Gary Patureau, Christine Melancon, Shawn Deane, and Rita Wilson.  Gary and Christine have both been on the NAMSAP Board for six years, and have given so much of their time and always put forth their full efforts.  While I know they will continue in other capacities, including the Committees and Advisory Board, I want to thank them for all of the time and hard work they have put in the over the years for the betterment of NAMSAP, and for just being all-around wonderful people.  I also thank Shawn Deane, our Past President, who recently resigned from the Board after having served there since his appointment in 2014.  Shawn’s willingness to lend a hand and weigh in on a wide range of topics, given his breadth of knowledge and experience, has been so invaluable.

 

I would also be deeply remiss if I did not thank Kim Wiswell, also a past president, for her six years of service on the Board.  Having heard Kim’s name in the industry for years, I was excited to serve on the Board with her, and came to see first-hand her eagerness to lend her hard work, collaborative insight and knowledge base to the Board.  I have really enjoyed working with Kim, and am thankful that she has also agreed to remain on the Advisory Board.  I thank Kim for the time she has spent as President, and for all of the work she has put in on the Board throughout the years.

 

Finally, I would like to extend my deep gratitude to Rita Wilson, who has been a strong and steadfast leader for this group, and who made so much progress in moving NAMSAP forward over the last year.  I have really gotten to know Rita over the last couple of years, and have developed a deep respect for her as a leader, businesswoman and industry changer.  She has also become my friend, and I am deeply grateful to NAMSAP bringing us closer.

 

In looking forward to 2019, NAMSAP has a lot planned.  We will continue with our strategic plan, which has been revised and updated for 2019.  The Data and Development Committee will continue to monitor inclusion and exclusion of treatments and medications in the MSA, pricing used, and to identify trends for our members.  The Education Committee already has eleven webinars scheduled, and has one more in the works. The MSCC subcommittee will continue to oversee the MSC training modules, make updates as needed, and score the MSCC final practicum submissions.  NAMSAP will also offer test proctoring before our annual educational meeting.  If you know of anyone interested in taking the examination, please feel free to direct them to for NAMSAP’s approved program.  The Evidence-Based Medicine Committee will continue to work toward resolving the opioid problem in the MSA, as well as push for more evidence-based allocations and address overfunding of the MSAs.  We plan to continue to use our legislative allies as needed.  The Policy and Legislative Committee, in partnership with our other committees, will continue to monitor and evaluate legislation that impacts MSP compliance, identify problems the industry sees with CMS allocations in the MSA, and address hiccups in the conditional payment recovery progress.  The Liability Committee will work with the Policy and Legislative Committee in talks with CMS about liability MSAs to ensure that, should CMS put liability MSA policies in place, the program makes sense with sufficient protection of the Medicare trust fund while simultaneously ensuring payers do not overpay.  The Membership Committee will try to increase membership and corporate partners.  The Communications Committee is looking forward to a marketing rebrand and website overhaul, as well as forward-thinking social media opportunities.  Finally, the Annual Meeting Subcommittee has already started planning a fantastic fall 2019 program, which will include speakers from CMS and its contractors.

 

I am inspired by the optimism and camaraderie I have found in NAMSAP, and look forward to a productive and dynamic year.  I welcome our new Board members:  Daniel Anders, John Kane, Steven Miller, Kevin Puckett and Tom Stanley to the Board.  I look forward to working with every one of you, and to taking this professional group of industry leaders into 2019.

 


 

  

Partner Spotlights

GOLD SPONSORS
       

 

  


02 | HIGHLIGHTS OF THE "MSP 2018: YEAR IN REVIEW" WEBINAR

 

By: Rasa Fumagali, JD, MSCC, CMSP
Partner
Nyhan Bambrick Kinzie & Lowry

NAMSAP’s 2019 webinar series began with the annual recap of MSP compliance highlights from the previous year. My co-presenters, Daniel Anders of Tower MSA Partners, Ciara Koba of Gordon & Rees, and I discussed some of the changes that took place in 2018 . We also looked ahead to some of the events that are likely to unfold in 2019.  If you were unable to join the webinar, the major points are outlined below. The webinar was also recorded and may be purchased on the NAMSAP website.

Highlights of 2018

  • Capitol Bridge LLC took over as the new Workers’ Compensation Review Center Contractor
  • Two releases of the Workers’ Compensation Medicare Set-Aside Arrangement Guide in 2018
    • March 19, 2018, Version 2.7
    •  October 1, 2018,  Version 2.8
  •  Performant took over as the new Commercial Repayment Center Contractor
  •  Expansion of Medicare Advantage Plan recovery attempts

January of 2019

  • January 4, 2019 Version 2.9 release of the Workers’ Compensation Medicare Set-Aside Arrangement Guide
    •  Clarification regarding Lyrica analysis
    •  Examples of situations where future medical allocation was appropriate even when CMS workload review threshold is not met
    •  Use of 2015 CDC Life Table
  •  January 5, 2019 new functionality on the Medicare Secondary Payer Recovery Portal
    • Self-report when no ORM
    •  New Multi-Factor Authentication method

Looking Ahead to 2019

  • Possible expansion of Amended Review process
  • Change in policy as to how CMS will review and approve $0 WCMSAs
  •  CMS will solicit opinion regarding imposition of Section 111 penalties for non-compliance
  •  CMS will solicit opinion regarding voluntary Liability MSA review process

We will continue to monitor changes throughout the year and issue updates.

LEARN MORE ABOUT WEBINARS >

 

 



03 | MSCC PRE-CERTIFICATION

The Medicare Set-Aside Consultant Certified (MSCC) credential is designed to identify those professionals who work within the Workers’ Compensation or Liability insurance benefit system as either health care professionals, legal representatives, or as insurance claims adjusters, who have completed specific pre-approved training in Medicare Set-Aside Arrangements, and have demonstrated a breadth of knowledge regarding the development and application of the Medicare Set-Aside Arrangement process.  Additionally, this credential is designed to express to the consumer that the person holding the MSCC credential has agreed to come under the scrutiny of a certifying review board (ICHCC), to be peer reviewed, and to adhere to a set of standards governing ethics and professional behaviors. 

New pricing available!

NAMSAP is pleased to announce the fee to enroll in the pre-certification program is now reduced to $650 for members. Once you complete the program, there is an additional $250 fee for a peer-reviewed practicum.  In addition, by completing the NAMSAP course, you may sit for the proctored exam in Baltimore in September for no additional fee!

Learn more about the program on the NAMSAP website.


Partner Spotlights

SILVER SPONSORS

       

       


04 | COMMITTEE HIGHLIGHT

 

By: Michelle Allan
Partner
Gordon & Rees Scully Mansukhani

Monica Williams, BSN, RN, CCM, CRRN, LNC, MSCC, CMSP
President
MWC Associates, LLC

 

NAMSAP’s Membership Committee is recruiting! If you are interested in becoming more involved in NAMSAP, we have room on our Committee for you! The Membership Committee is strategically positioned for growth in 2019, building from the history of success over the previous years. Our philosophy for 2019 is to continue raising the profile and prestige of NAMSAP as the leading industry organization for Medicare Secondary Payer interests. Our goals for 2019 include:

  • Raising overall membership 5%, which would reach a goal of 550 members, edging above our five year high of 546 set in 2013.
  • Converting corporate partnerships from silver and bronze to gold or platinum. We are interested in feedback on what membership benefits are of value!
  • Increasing primary payer membership. Primary payers offer NAMSAP hands-on experience and insight that adds dimension to our collaborative culture.

We are working closely with the Communications Committee this year to develop effective messaging and appropriate outlets to disseminate all of the good things NAMSAP is doing, and how they can benefit from our organization. Information is powerful in MSP practice. NAMSAP is a liaison for the exchange of information and ideas, as well as a center for advocacy, which should make membership attractive to prospective members.

 

Some critical selling points for new members are as follows:

 

  • Membership encourages membership.
  • NAMSAP is a visible leader in MSP industry development.
  • NAMSAP can help build your practice with networking and presentation opportunities.
  • Partnership with NAMSAP establishes contacts with national, state and regional industry leaders.
  • Membership offers exposure and opportunities to be a part of a growing organization.

 

With grassroots efforts and a strategic focus on recruiting, we believe we can reach our goals. We can share more details at our next meeting on the third Thursday of the month if you would like to join the Membership Committee!

 


Partner Spotlights

 

BRONZE SPONSORS

            

          

    

 

    NYC Law Department Office of Corporation Counsel
    The Hartford


05 | SUBSCRIPTION SERVICES

 

 

NAMSAP Subscription Services: Access to State of the Art Medical and Pharmacy Data at Discounted Rates

 

NAMSAP is pleased to offer members discounted subscription services to assist you in providing the highest quality services to your clients and patients. Members receive special discount pricing on service such as:

  • Truven Health Analytic's RED BOOK
  • ODG by MCG

Do not miss the opportunity to save big while receiving the best resources in the market! Click here for more information!

 


06 | STRATEGIC GOALS

 

NAMSAP's committees have set their strategic goals for 2019.  Below is a list of the committees - we encourage you to contact the co-chairs to volunteer your expertise as part of the committee.

  • Annual Meeting Committee
    • Co-Chairs: Michelle Allan, mallan@grsm.comGary Patureau, Gary@Lasie.org
    • Strategic Goals: The Sub Committee expects to match the success of the 2018 meeting and exceed the attendance. With a commitment from CMS to attend next year combined with their great participation and co-operation we are well positioned . Baltimore has been selected to ensure CMS attendance and a great new hotel will be an additional draw.
  • Communications Committee
    1. Repositioning and Rebranding in Industry
      • NAMSAP logo and branding overhaul
      • Plan is to seek feedback from the BOD regarding messaging, goals, and direction for rebranding
      • Hire a marketing/PR firm to assist with rebranding after formal RFP
      • Update content on the website links
    2. NAMSAP Advisor / Membership communications
      • Review other options to the NAMSAP Advisor for member communications and submit to BOD for approval.
      • Evaluate a “ What’s New “ blast of only important topics.
      • Establish access restrictions to certain content to further promote membership
    3. Define a communications format & process for more timely communications via NAMSAP Advisor Bulletins.
    4. Work with AMS to increase social media presence and postings.
    5. Work with Membership and Webinar Committees on joint projects to increase participation in the organization and the presentations we are providing
    6. Research starting a Podcast. Possible podcasts might be…
      • Interview with CMS
      • Interview with NAMSAP president about hot topics
  • Data and Development Committee
    1. Monitor the WCRC regarding inclusion/exclusion of treatment
    2. Monitor the WCRC regarding inclusion/exclusion of medications
    3. Monitor the WCRC in regards to accepting UR decisions
    4. Monitor pricing of services and medications
    5. Monitor CMS approval as submitted
    6. Monitor the TAT of approval
    7. Monitor the TAT of re-reviews
    8. Identify trends to bring to the attention of NAMSAP leadership that warrant follow up with CMS.
    9. Increase committee membership to obtain greater pool of data
  • Evidence Based Medicine Committee 
    1. Resolve opioid issue in the MSA – bring Congressional committees up-to-date, seek resolution with a timeline
    2. Address lack of evidence-based support for labs being included with every medication, even when not medically indicated
    3. Address lack of evidence-based support for urinary drug screens being included quarterly with Schedule II opioid, even when not medically indicated or no actual utilization shown
    4. Address overfunding of MSAs – imaging, follow-up visits, etc.
    5. Obtain Congress’ agreement to push CMS to track data such as spend-down of MSAs, what is being utilized and what is not, how many beneficiaries do not live to full life expectancy, etc.
    6. Look at all Federal Bills involving pharmacy and treatment, and review for applicability to the MSA and whether we might be able to get language in these bills or obtain support of the bills’ sponsors 
  • Liability MSP Advisory Committee
    • Co-Chairs: William Delaney, wad@nbkllaw.comThomas Stanley, tomstanley@cox.net
    • Strategic Goals: In 2019, the LMSA Committee plans to expand upon what was begun in 2018. The major event in 2018 was the meeting with CMS, where CMS provided us with their thinking regarding a LMSA Review Program. The goal for 2019 is to engage CMS in further discussions with the goal of partnering with CMS in a "what if" or pilot program.  This program will help to identify the correct thresholds, formula(s), and process for a LMSA program.  This goal will be accomplished by:
    1. Mr. Forry requested a letter regarding our thoughts on LMSA’s at the annual meeting. This letter was sent in December.
    2. The letter requests an informal telephonic meeting by January 15, 2019. This meeting is to discuss the contents of the letter, hopefully leading to a follow-up meeting where the pilot program begins to take shape.
    3. In the meantime, the LMSA committee will solicit “real-life” LMSA cases to use in the pilot program.
    4. If such a program is developed, meeting with CMS (in person and/or telephonically) could be on a monthly basis.
  • Membership Committee
    1. To raise overall membership 5%, which would get us to 550 total members putting us ahead of the five year high of 546 members set in 2013.
    2. Corporate partner conversions from silver and bronze to gold or platinum.
    3. Increased membership from primary payers.
  • MSCC Committee
    • Co-Chairs: Christine Melancon, christinem@cobaltcp.com; Fran Provenzano, fran@msaspecialists.com; Leslie Schumacher, Lschumacher@planpointmsa.com; Kimberly Wiswell, kimberly.w@claraanalytics.com
    • Strategic Goals: The Sub Committee will oversee the MSCC training modules, make updates as needed, and provide professional expertise to grade all MSCC final practicum submissions. Working in conjunction with AMS, the committee will make recommendations as to changes needed in process, content and practicum oversight.
  • Policy & Legislative Committee
    1. Monitor and evaluate legislation impacting MSP compliance and provide recommendations to the Board regarding NAMSAP involvement in legislative activities. Continued involvement with MARC on the PAID Act and continued discussions with UWC, on its MSA reform bill, is anticipated.
    2. In partnership with the Data Development Committee, identify apparent inappropriate trends in CMS allocation of medical care in the MSA and escalate these matters to CMS management. Pending matters, which may continue into 2019, are the inclusion of Lyrica and the frequency of Urine Drugs Screens allocated in the MSA.
    3. Identify problems in the Medicare conditional payment recovery processes and escalate these matters to CMS management for response and resolution.
    4. Develop policy proposals to improve MSP compliance processes, such as the review and approval of $0 MSAs and expansion of ORM termination bases.
    5. Whether through legislation or direct CMS policy change, advocate for CMS adherence to state WC statutes in the allocation of medical care in the MSA.
  • Webinar Committee
    • Co-Chairs: Kimberly Wiswell, kimberly.w@claraanalytics.comJennifer Shymanksi, JShymanski@mynuquest.com
    • Strategic Goals: Tentative Webinar schedule for the remainder of 2019
      • 02/12/19 ODG - Tom Farrell
      • 03/12/19 TBD
      • 04/09/19 Conditional Payments & Appeals
      • 05/14/19 LMSA - Status/Update - LMSA Committee Speakers
      • 06/11/19 TBD
      • 07/16/19 Data & Development Committee Update – Fran Provenzano
      • 08/13/19 EBM: Part IV (Opioids) - Amy Bilton, Gary Patureau
      • 09/10/19 Legal/ Legislative Update
      • 10/15/19 Annual Mtg - Possible CMS Activity Pop-up
      • 11/12/19 MSA Cost Mitigation Techniques
      • 12/10/19 Annual Ethics - Tom Spratt, Fran Provenzano, Shawn Deane
 

 

National Alliance of Medicare Set-Aside Professionals
620 Florida St., Suite 210 | Baton Rouge, LA 70801

P: 225-454-6164 | F: 225-344-1132
www.namsap.org | info@namsap.org

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