Inviting the wolves into the hen house

One of the blights on the Medicare Set-Aside (MSA) industry is the aggressive sales tactics employed by some vendors to generate revenue. Readers of this blog know that MEDVAL believes that the MSA process is a consultative, professional service, best performed by highly skilled legal, medical and financial professionals. However, other firms look at an MSA as a commoditized widget to be aggressively pursued and sold by a sales force long on ambition to earn a commission check but short on qualifications or claims handling ability.  Take a look at the website for the industry's most active trade organization, the National Alliance of Medicare Set-Aside Professionals (NAMSAP).  Most of the employment listings are for sales reps with very little required in the way of qualifications.

With the advent of the new reporting requirements found in the Medicare, Medicaid, and SCHIP Extension Act  (MMSEA), some firms have seized on a new marketing gimmick to drive revenue and generate claim referrals. In exchange for an exclusive MSA relationship and maybe a small fee, they will handle all the reporting requirements for the Responsible Reporting Entity (RRE).

Here is what they don’t tell you…

1. They have no experience building or maintaining an electronic interface with the Centers for Medicare and Medicaid Services  (CMS)  or managing an IT project requiring change management from within a client organization.
2. The difficulty in compliance with the MMSEA Section 111 reporting requirements is not interfacing with CMS but gathering the required fields from legacy claims systems and changing the way information is developed by the claims handler.
3. Once these firms have a master list of all eligible Medicare beneficiaries, each claims office can expect a nonstop badgering of front line claims professionals so that the local “field rep” can meet this month’s sales quota.
4. Offers to indemnify a payer against CMS penalties are virtually meaningless since several of these firms failed to live up to the last great marketing gimmick :  the “guaranteed MSA”.  All that was accomplished by the guaranteed MSA was an increase in the loss costs of payers due to millions in overfunded MSAs with a negative net benefit to clients that were oversold and underserviced.
5. Instead of having the flexibility to choose a best-of-breed MSA provider, you may now be now locked-in to higher MSA fees (nothing is really free is it?), questionable work product and a dysfunctional vendor relationship where the vendor dictates terms because of the  difficulty of transitioning a CMS reporting relationship once established.

MEDVAL has agreed to act as an agent for a couple of fairly small regional clients since they don’t have the resources to comply with the IT challenges. Our internal claims system accepts data transfers from clients and will be compliant with CMS protocols once they are fully developed.

However, you will never see us market this service as a way to capture MSA business.  We strongly believe that any sizable claims organization has ample resources to handle this requirement internally with minimal resources.  

Giving an MSA vendor with a large hungry sales force access to a target rich list of confidential claims data is sort of like leaving the wolf to guard the hen house. 

Concerned about the MMSEA Mandatory Insurer Reporting Requirements?  Need a little help? Call 888-SET-ASIDE or e-mail us at info@medval.com.

MEDVAL 1-888-SET-ASIDE

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