Hold onto your hats, because Medicare compliance is about to shake things up this April. If you thought settlements under $25K were flying under the radar, think again— changes are coming, and payers need to be prepared.
Let’s break it down with the 5 must-knows to ensure you’re ready.
1. Small Settlements, Big MSAs
Brace yourself—gone are the days when settlements under $25k could coast by. Now, even these smaller cases require an MSA calculation. That means no more quick-and-easy closures—every penny needs to be accounted for. Preparation is key to ensuring compliance without last-minute surprises.
2. Crunch Those Numbers!
With this change, payers need to put on their math hats and develop a solid method for appropriately calculating the MSA. There’s no universal magic formula (sorry!), so it’s up to each organization to ensure they’re compliant. Time to sharpen those pencils (or fire up those spreadsheets) and get your calculations ready before the deadline hits!
3. Section 111 Reporting Gets an Upgrade
Think of this as a software update you can't skip. Payers need to update and test their Section 111 reporting functionality to align with the new requirement. If you’re not prepared, expect some system headaches—so don’t wait until the last minute to run those tests! Make sure your reporting systems are ready to withstand these new regulations.
4. Get Your Data in Order
Speaking of Section 111 reporting, accuracy is key. Payers must confirm that all future reports include the necessary new data fields. If you’re missing critical info, you could face compliance issues—and no one wants that kind of attention! Double-check your data now to avoid scrambling later.
5. Don’t Forget the Legal Fine Print
If an MSA is required for settlements under $25K, then it needs to be properly documented in the settlement agreement. That means conferring with legal to ensure everything is buttoned up tight. Plus, injured workers need to actually understand their MSA and what’s required of them—so communication is just as critical as compliance. Secure legal alignment now to prevent turbulence down the road.
The Bottom Line: Prepare Now or Scramble Later
April is coming fast, and these changes aren’t optional. Payers who plan ahead, update their processes, and work closely with their legal teams will navigate these updates smoothly.
The good news? EK Health has your back! As part of your preparation strategy, we offer services for cases where the claimant is Medicare-eligible and the settlement is under $25,000. Our streamlined process ensures you get a realistic MSA amount without the hassle of compiling a full chronology of treatment. And the best part? We provide this service at a flat fee, making compliance easier and more cost-effective.
So, are you ready to brace for impact? Let’s make sure your Medicare compliance is in shipshape before these changes hit!
