Leave a comment

Medicare Regional Coordinator Sally Stalcup at TTLA Convention

Sally Stalcup – MSP Regional Coordinator, CMS Dallas Region – spoke for half an hour at the TTLA Annual Convention in Austin, Texas on June 1, 2011. Some highlights include:

  • She prefaced the talk with a statement that she cannot comment on recent cases/litigation. Perhaps she referencing Haro v. Sebelius. On Medicare Set-Asides (MSAs)
  • MSAs are not required – but they are CMS’s vehicle of choice. All the law says is to “protect the Medicare Trust.”

On MSPRC delays and backlogs

  • There is a backlog at the MSPRC – she guesses to “probably allow double” the quoted time
  • She can’t really help you with MSPRC issues

On the MSPRC generally

  • She does not think it will ever be as fast or as smooth as everyone wants
  • They have 100,000+ cases
  • They have inefficiencies that need attention, they have improved many things, and they have a long ways to go
  • Data on MSPRC gains vs. cost of operation does exists, but she does not have it

On the difference between CMS and the MSPRC

  • She seemed to intimate there is a divide and possibly lack of cooperation between CMS and MSPRC
  • This is not a philosophical divide – simply stressing they are two very different organizations
  • She spoke about her own attempts to get disputed charges removed and how the “contractor” (a/k/a the MSPRC) will not agree with her On the speed of Medicare Lien resolution.

Is it quicker to sue CMS/MSPRC?

  • Yes – to a point
  • Keep in mind Sally does the research for their legal counsel – so she knows they are now less likely to negotiate now than in the past
  • Procurement formula still exists even in a suit vs. CMS and MSPRC because of 42 CFR 411.37
  • She argues volume is the reason why other insurers are so much faster
  • She asked listeners to keep in mind there are other aspects to MSP (beyond liability – which is the biggest portion)
  • Question: changes in the last 2 years? It is “as bad as before MSPRC.”
    • Some things have changed
    • Best thing to point to is Mandatory Insurer Reporting
    • Brings novices to the table (attorneys who have just started to deal with Medicare liens)
    • Brings more cases

On No-Fault cases

  • No procurement in no-fault cases
    • You can try to get procurement applied by arguing action was taken to argue with the insurance company
    • Stressed that you must prove it is deserved

On Waivers

  • Purely financial decision
    • Sec. 1870 of SSA gives the right to a waiver
    • Reviewer must ask: would a lien take away the funds that the person needs for daily living expenses
      • E.g., person working before but cannot now; modified home; independent and now in nursing home w/ no insurance
    • If the person is “comfortable” they will not get a favorable response
    • Current status matters – if dire straits now – then it will be granted

On the MSPRC notes system and receipt of your letters

  • She knows the MSPRC system from visiting its office and sitting in on phone calls
    • They document phone calls. But the rep must log/document the matters discussed
    • Possible that certain reps fail to document some calls
    • Lists of calls made is kept automatically (verifiable even if not logged)
  • Not receiving mail – e.g., MSPRC says it never received a document, you have a fax confirmation
    • Send those proofs to Sally and she will “yell at somebody” – but she cannot make the missing document suddenly appear
  • Vast majority of people on MSPRC phones are doing the best they can
  • They get a tremendous amount of abuse from people across the country

 

Dealing with Medicare always comes back to two things: (1) Preparation; and, (2) Dedication (continuous follow-ups with the MSPRC, of course).  If you need assistance with Medicare liens, Medicaid liens, ERISA liens, or any other healthcare liens, contact LRS.  LRS can help resolve all healthcare liens.  Please contact us for more information.

 

Ryan J. Weiner
Co-Founder Lien Resolution Services
www.lienresolutionusa.com
https://lienblog.wordpress.com
rweiner@lienresolutionusa.com
This Blog/Web Site is made available by the publisher for educational purposes only as well as to give you general information and a general understanding of the law, not to provide specific legal advice. By using this blog site you understand that there is no attorney client relationship between you and the Blog/Web Site publisher. The Blog/Web Site should not be used as a substitute for competent legal advice from a licensed professional attorney in your state.
Advertisements

About Ryan J. Weiner

Co-Founder of Lien Resolution Services, LLC, a national healthcare lien resolution firm. Our goal is to assist in the fair administration and resolution of healthcare liens on personal injury cases. Please visit our website for more information: www.lienresolutionusa.com.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: