CMS Awards Contract for Review of MSA Submissions
Despite receiving "counter higher" rejections from CMS -- hundreds of thousands of dollars higher -- some MSA firms continue to offer their clients deceivingly low MSA figures based on drug utilization reviews (DUR) that CMS continues to reject.
With the May 14th publication of the CMS policy that allows MSA providers to exclude off label drugs from the MSA allocation reports, the value of pharmaceutical drug reviews as an option in helping to reduce drug costs has been highlighted.
Currently, one of the most talked about MSA topics is off-label drug costs. The CMS May 14, 2010 policy memo (which can be read at our website) allows off-label drug costs to be excluded from MSA's. However, claims handlers, attorneys, and MSA providers have been dismayed by the inconsistencies in CMS application of this policy memo.
Not every Medicare Set Aside (MSA) must be submitted to CMS for review and approval. While the Medicare Secondary Payor Act requires that all secondary payor claim settlements consider Medicare's interests, there are CMS review thresholds that must be applied to determine which MSA's need CMS approval.
When CMS wants more documentation than is included with a proposed MSA, CMS sends a "development letter," requesting further information. If CMS does not receive the requested material within thirty days, the file is closed without completion of a review, and the proposed MSA remains unapproved.