The Centers for Medicare and Medicaid Services (CMS) hosted a webinar focusing on enhancements to its Medicare Secondary Payer Recovery Portal (MSPRP) on December 18, 2018. The improvements discussed by CMS included a new “Self-Reporting” option for Non-Group Health Plan (NGHP) claims and updates to the multi-factor authentication (MFA) process. These changes will take effect on January 5, 2019. This article provides a general summary of highlighted points discussed by CMS on the webinar:
The MSPRP’s self-reporting functionality, previously announced as an impending upgrade, will enable a Medicare Secondary Payer (MSP) case to be electronically reported by a beneficiary or their representative, as opposed to the current lengthy phone option with the Benefits Coordination and Recovery Center (BCRC), or allow for an insurer or insurer representative trying to report a situation that is not otherwise appropriate to report via the current electronic Medicare, Medicaid and SCHIP Extension Act (MMSEA) Section 111 process.
Per CMS, insurers and their representatives should not report cases where ongoing responsibility for medicals (ORM) has been accepted, or a settlement has been reached. If either of these parameters is met, the system will automatically advise the user that the case cannot be submitted on the MSPRP and must be reported via the Section 111 reporting process.
If a case is ripe for reporting a series of required data fields, the provided information is validated to ensure the case does not already exist, confirmation of successful submission is provided and the Rights and Responsibilities (RAR) letter will automatically be mailed to all authorized parties. If the case already exists, the system will advise the user that the case is found and provide Case ID link(s) which will redirect the user to the existing case information page where they can access and manage the existing claim data based on their authority level.
Upon successfully creating a new case, CMS provides the user the option to add at minimum one, and maximum of 25 diagnosis codes. There is a Diagnosis Code search button available for those that do not readily have codes available that will likely be helpful to the reporting community. Mirroring current reporting requirements, if the Date of Accident/Incident is prior to October 1, 2015, diagnosis codes from either ICD-9 or ICD-10 code sets may be used. If the Date of Accident/Incident is on or after October 1, 2015, then only ICD-10 codes may be applied.
The importance of accurately reporting ICD codes cannot be understated as this will have direct impact on subsequent reimbursement requests. These types of errors often surface in the current Section 111 reporting process resulting in erroneous conditional payment line items. In addition to entering claim information, there is an option for the user to upload Authorization Documentation as well as Notice of Settlement Information. CMS indicated a Conditional Payment Letter (CPL) will automatically be mailed to the beneficiary and authorized parties following the claim retrieval process and if settlement information is provided, a Conditional Payment Notice (CPN) will issue.
Multi Factor Authentication (MFA) Update
CMS also provided an update to its MFA process advising the current system is being replaced with an MFA solution provided by OKTA. As of January 5th, current MFA users will no longer be able to provide their existing tokens but rather, through the new OKTA system, users will be offered the choice of voice call or text message authentication methods. Credentialed users will need to select the “Factor Required” link under the Multi Factor Authentication section of the welcome page and follow the steps to register their new authentication factor to view unmasked case information.
CMS advised that information related to this announcement will be available in the MSPRP User Manual. Additionally, CMS announced further MSPRP enhancements will be unveiled in the spring including a mechanism to support direct payment of conditional payment amounts owed.
ISO Claims Partners will continue to monitor any additional enhancements to the MSPRP and provide updates as warranted. In the interim, feel free to contact the author at firstname.lastname@example.org or 978-825-6010.