Hello again, fellow adjusters! Sheryl Thompson here, your Medicare Compliance specialist. It’s been several months since the 2024 WCMSA Update to the Self-Administration Tool Kit, and I’m still fielding questions about what it all means. So, I thought it was high time to revisit this topic, clarify a few things, and share some best practices we’ve developed in response to these changes.
Sheryl Revisits the 2024 WCMSA Update: New Insights and Best Practices
1. The Medicare Advantage Plan (MAP) and Part D Plan Puzzle: Two Months Later
The emphasis on MAPs and Part D plans hasn’t waned. If anything, it’s become even more crucial.
- New Best Practice: We’ve developed a “MAP and Part D Verification Protocol.” This involves not just asking about enrollment, but also verifying plan details directly with the providers. It’s an extra step, but it’s preventing a lot of post-settlement headaches.
- Ongoing Challenge: Many claimants still don’t understand the difference between traditional Medicare and MAPs. We’re working on better educational materials to address this.
2. The Communication Tango: Choreographing Better Outcomes
The requirement for claimants to communicate plan details hasn’t changed, but we’ve gotten better at facilitating this process.
- New Best Practice: We’ve started hosting “2024 WCMSA Update Workshops” for claimants. These 30-minute sessions, either in person or via video call, walk claimants through their responsibilities step-by-step.
- Success Story: One of our adjusters created a simple app that helps claimants track and report their WCMSA-related communications. It’s been a game-changer for compliance.
3. The Coverage Conundrum: Preventing Falls Through the Cracks
We’ve seen a few cases where claimants faced coverage issues due to non-compliance. Here’s how we’re addressing this:
- New Best Practice: We’ve implemented a “WCMSA Compliance Check-In Program.” This involves quarterly check-ins with claimants for the first year post-settlement, then annually after that.
- Emerging Trend: We’re seeing more requests from claimants for ongoing support. We’re exploring partnerships with case management services to meet this need.
4. The Annual Attestation Tango: Making It Second Nature
The annual attestation requirement is still tripping up some claimants, especially those in MAPs or Part D plans.
- New Best Practice: We’ve created an “Annual WCMSA Checklist” that we send to claimants 30 days before their attestation due date. It includes steps for attestation and prompts for reporting any treatment changes.
- Tech Solution: We’re piloting an automated reminder system that sends text and email reminders to claimants about attestation and reporting requirements.
5. The Complexity Conundrum: Streamlining Our Approach
WCMSA administration hasn’t gotten any simpler, but we’re getting better at managing the complexity.
- New Best Practice: We’ve developed a “WCMSA Administration Flowchart” that maps out the entire process, from initial setup to ongoing management. It’s helping both adjusters and claimants visualize the process better.
- Training Update: We’ve revamped our internal training to include more case studies and practical scenarios. It’s helping new adjusters get up to speed faster.
6. The Allocation Anticipation: Trends We’re Seeing
As suspected, we’re seeing some changes in how WCMSA allocations are being reviewed:
- New Best Practice: We’re now including a “Prescription Drug Cost Projection” section in our WCMSA proposals. This detailed breakdown is helping to justify our allocations more effectively.
- Emerging Trend: CMS seems to be paying more attention to the coordination between WCMSAs and MAPs/Part D plans. We’re adjusting our proposals to highlight this coordination more explicitly.
Wrapping It Up: Lessons Learned and Looking Ahead
These past few months have been a learning experience for all of us. The changes introduced in the 2024 WCMSA update have certainly added complexity to our work, but they’ve also pushed us to innovate and improve our processes.
Key 2024 WCMSA Update takeaways:
- Communication is more critical than ever. Clear, consistent, and proactive communication with claimants is essential.
- Education is ongoing. We need to continuously educate ourselves, our teams, and our claimants about these evolving requirements.
- Technology can be a powerful ally. From reminder systems to compliance tracking apps, tech solutions are helping us manage the increased complexity.
- Flexibility is crucial. As we continue to see how these changes play out in practice, we need to be ready to adapt our approaches.
Remember, adjusters, while these changes have made our jobs more challenging, they’ve also elevated the importance of our role. We’re not just processing claims; we’re ensuring that claimants receive proper care while protecting the integrity of the Medicare system.
Keep up the great work, stay curious, and don’t hesitate to reach out if you’re facing challenges. We’re all in this together, and together, we’re not just adapting to these changes – we’re thriving in spite of them!
Here’s to continuing to navigate the ever-changing waters of Medicare compliance with skill and dedication!
References and Further Reading
- Centers for Medicare & Medicaid Services. (2024). Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Self-Administration.
- Centers for Medicare & Medicaid Services. (2024). WCMSA Reference Guide (Version 4.1, August 1, 2024).
- Medicare Secondary Payer Recovery Portal. (2024).
- Social Security Administration. (2024). Medicare Information.
