Movers & Shakers: 6 Questions with New MSPN Pres. John Kane

Sarasota, FL (WorkersCompensation.com) -- Last month, the National Medicare Secondary Payer Network elected John P. Kane, AIC, CMSP-F & MSCC as its president. The non-profit association focuses on MSP compliance and Medicare Set-Asides and their impact on workers' compensation and liability settlements.

Kane, who is the vice president of strategy for Ametros, stepped into the role to oversee the organization's educational, advocacy, and partnership initiatives during a one-year term. We recently caught up with Kane, who answered our questions about the new post and the future of MSPN via email. 

What does it mean to you to be elected president of MSPN?

It is a privilege to be elected by the board to carry out MSPN’s mission.  As president, I will continue to promote fair and reasonable Medicare Secondary Payer reform efforts for primary payers and injured workers.  I will foster our mission to serve as the leading advocate for an efficient and effective MSP compliance system and as the industry resource for all involved parties. We have a diversified organization with over 500 members including attorneys, nurses, structure settlement brokers, professional administrators, third party administrators and insurance carriers.  Our members and corporate sponsors are responsible for the vast majority of voluntary CMS submissions, Sectional 111 Reporting and Conditional Payment reviews.  I appreciate the opportunity to lead this organization and create further transparency and work efficiencies with CMS. 

What do you feel is the most important objective for MSPN to accomplish in the short term and long term?

The most important objective is identifying Medicare Secondary Payer (MSP) trends and evaluating to see if corrective action is needed. In the short term, we are monitoring the recent Request for Proposal for the Workers Compensation Review Contractor (WCRC) with an effective contract start date of April.   If there is a change in contractor, we will monitor the MSA pricing, frequency and turnaround times and provide our feedback directly to CMS officials.  We will accomplish this through our data committee, member feedback and ongoing communication with CMS.  

Our longer-term objective is to create an MSP compliance dashboard on how as an industry we are doing with the different aspects of MSP compliance.   We recently created a CMS MSP Research Project sub-committee to evaluate the major areas of Medicare compliance: Section 111 reporting, conditional payments, Medicare Set Asides (MSAs) and post-settlement compliance. We shared our key metrics and rationale with CMS and how the information would be useful to the MSP community.    

Following our request, CMS did release key metrics on its WCMSA Review Program. The data compared proposed MSA amounts with the CMS-recommended amounts over the last 3 years.  While this is a good start, there are additional key metrics, such as timely and accurate Section 111 Reporting, accuracy of conditional payments and post settlement MSA spend and administration that will provide us with further insight.   We will continue to work with CMS to request annual key metrics and metrics year over year to better understand trends.

What in your professional experience do you feel will be your best tool in the MSPN role?

I have passion for MSP compliance with 30 years in claim management, including 15 years as the Director of Medicare compliance for one of the larger WC insurance carriers.  My leadership, experience and communication are well suited for this role.   

How do you feel that your work at MSPN will apply to your work at Ametros?

As president, I have the opportunity to engage with some of the best people in the business.  Ultimately, we want to tee injured workers up with a good settlement and post-settlement experience and continuation of medical care. I participate in the various MSPN committees, identify current trends and share what I can with my fellow colleagues at Ametros. The MSPN community is great for education and supporting one another. I love the phrase, “When you are green you are growing.”  I also want to give a shout out to the adjusters and attorneys that work hard ensuring the injured worker receives the care needed.   Adjusters and attorneys can help the injured worker post settlement with reasonable medical allocations and professional administration. CMS highly recommends professional administration. 

What reforms would you like to see that could potentially benefit the MSP industry?

• Open ended Amended Review Process to all past CMS determinations that haven’t settled.  This process is currently limited to a six-year lookback.  This would enable Medicare beneficiaries the opportunity to settle out their workers compensation medical benefits and have freedom of choice to treat with a physician without independent medical exams (IMEs) and utilization reviews.  This would unlock opportunities for primary payers to settle older cases with outdated CMS determinations. 
• Advocate for broader On-Going Responsibility for Medicals (ORM) Termination criteria.  This would help the injured worker when they are no longer treating for the work injury and have an intervening accident.  This would improve benefit coordination and eliminate unnecessary denials and frustration. 
• Repeal of the MSP “Private Cause of Action.” The Medicare Advocacy and Recovery Coalition (MARC) led by David Farber with Spaulding & King advocates for improvement of MSP programs seeking legislative and regulatory reform efforts. MSPN became a member of MARC in 2021; the organization serves as our voice on Capitol Hill. MARC will be re-introducing the Repair Abuses of MSP Payments (RAMP Act – H.R. 8063) with the support of MSPN.

What do you feel people should know about MSPN currently but may not?

MSPN’s vision is to drive action through educational programs, resources, legislative advocacy, and a focus on sharing information amongst all in the community.  MSPN has fostered a very good working relationship with CMS holding periodic meetings to raise concerns with trends, discuss new policy clarification and how we may work more efficiently together.  

We welcome all new members as we continue to expand and diversify our association.  If you are not a part of MSPN, please consider joining today,  https://mspnetwork.org/   Our MSPN Annual Conference will be in Baltimore, Md., on Nov. 8-10 at Hotel Arundel.

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