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07 Feb 2013
John Williams
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To Our Valued Clients,

It has been an exciting start to 2013 for those of us in the Medicare Secondary Payer (MSP) Compliance industry. Garnering the most attention has been our Legislative Division with the passage of the SMART Act which our staff, Roy Franco and Katie Fox, have been intimately involved in since 2007.  You can register to hear our recently recorded webinar, presented by Roy Franco, showing the anticipated process CMS will use.  Thank you to all of our clients and partners who have joined the efforts in Washington to bring common sense reform to the MSP process.  We still need your support in 2013, as the next step is the development of the regulations which will govern the SMART Act in the future.

From the Medicare Set-Aside (MSA) world, Franco Signor is proud to announce our partnership with Healthcare Solutions to address the issues of high pharmacy costs in MSA Allocations.  The Pharmacy Management Program pilot over the last 6 months has helped reduce CMS approval values on high Rx MSAs by 61%, on average, through a modified and demonstrated change in the Rx regimen.  Healthcare Solutions has pharmacy solutions that address not only claims moving towards settlement, but ongoing and active claims that need their specialized clinical intervention.  We are pleased to bring our clients pharmacy solutions that make sense and work in improving settlement outcomes from the industry’s premium provider.

On the Conditional Payment front, clients should review the recent update from Jeff Signor on the Avandia decision as Medicare Advantages Plans are looking to capitalize on the decision and recover their medical spend in situations where primary plans exist.  Here is our original article on the decision.  Franco Signor’s Advantage & Pharmacy Plan Solutions proactively address these issues and we look forward to assisting our clients integrate this into their existing Conditional Payment Resolution Process.

In the realm of Mandatory Insurance Reporting, Franco Signor recently published an article on Medicare Recovery Audit Contractors.  With our MIR/MSP Audit Solutions we have developed automated routines, processes, and systems to analyze MIR/MSP compliance across a primary plan’s book of business using basic MIR data points. Since then, we have completed several audits of MIR data from various self-insurers, insurers, and TPAs.  The results vary from strong compliance to “I rather not talk about it,” but no one has yet to receive a 100% Compliant Certification.  The lesson learned is that clients should not be lulled into a sense of security that all is well on the MIR front, particularly if Medicare gets serious about using the RAC Contractor this year or in 2014.

With respect to Company News, we are excited to have Bennett Pugh join the Franco Signor team in January of 2013. Ben brings a wealth of industry knowledge and relationships to our expanding organization.  His experience in the MSP space adds to our already deep knowledge base.  Also, please don’t miss our feature presentation at the Orlando WCI Conference this year when we will be assembling an All-Star cast to discuss Federal involvement in claims and the changes that will impact the industry in the future.

We look forward to keeping our clients up-to-date on the rapidly changing MSP market in 2013.  To join our distribution list and stay current on the changes in the market click here.  To learn more about Franco Signor and our MSA Rx, Conditional Payment, and MIR/MSP Audit Solutions please contact Jesse Hamby at jesse.hamby@francosignor.com.  Thank you to all of our clients and partners that made 2012 a year to remember.  We look forward to continuing to serve your individual needs in the year ahead.

John M. Williams


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