Category Archives: Blog

Blog, LMSA

A proposed rulemaking on “Miscellaneous Medicare Secondary Payer Clarifications and Updates” has been posted on the Office of Management and Budget website. The proposed rulemaking can be found here. The abstract of the rule states:  “This proposed rule would ensure that beneficiaries are making the best health care choices possible by providing them and their representatives with the opportunity to select …
READ MORE

Blog, Medicare Conditional Payments, Medicare Jurisdiction

As required by section 202 of The SMART Act, CMS is required to annually review its costs relating to recovering conditional payments as compared to recovery amounts. For the last two years 2017-2018, CMS has maintained the threshold of $750 across all non-group health plan (NGHP) lines of business- workers’ compensation, liability, and no-fault insurance. The threshold means that if …
READ MORE

Blog, Medicare Secondary Payer News, Medicare Set Aside, Pharma Part D, WCMSA

What is the intended purpose behind a Workers’ Compensation Medicare Set-Aside (WCMSA)? The WCMSA Reference Guide, Section 3.0 states: “A WCMSA allocates a portion of the WC settlement for all future work-injury-related medical expenses that are covered and otherwise reimbursable by Medicare (“Medicare covered”) (emphasis added). Accordingly, Medicare through its issued guidance has provided that medical expenses should not be …
READ MORE

About Franco Signor, Blog, Franco Signor News

In December 2017 last year, I attended the Women to Watch conference hosted by CLM/Business Insurance in New York City. During the conference, the newly formed Women to Watch Foundation was introduced to the attendees by the Board of Directors with the common goal of advancing women and girls globally. For the initial two years of its Charter, the Women …
READ MORE

Blog, Medicare Secondary Payer News, Pharma Part D

Recently, CMS updated its Part D Manual to include specific changes to the Manual’s Medicare Secondary Payer (MSP) provisions.  The updated manual can be found here. Page 40 now provides: “Part D sponsors are responsible for adjudicating enrollees’ claims in accordance with MSP requirements. Under CMS’ adjudication logic for Part D MSP claims, the provider/pharmacy receives at least the Part …
READ MORE

MAPping Out a Course – An Article by Heather Sanderson

08 Oct 2018 Heather Sanderson No Comments

About Franco Signor, Medicare Advantage Part C

Primary plans must consider best practices as courts rule in favor of MAPs recovering double damages. Read Full Article from CLM Magazine 

Blog, Medicare Jurisdiction, Medicare Set Aside

As of October 1, 2018, both the Non-Group Health Plan (NGHP) User Guide and Workers’ Compensation Medicare Set-Aside (WCMSA) Reference Guide have been updated with minor changes. The updated NGHP User Guide can be found here and the updated WCMSA Reference Guide can be found here. Below are summaries of the changes in both of the Guides: NGHP User Guide: …
READ MORE

Blog, Medicare Advantage Part C, Trial Practice

Recall MSP Recovery LLC, a law firm out of Miami, Florida that has been initiating numerous class action litigation country-wide as assignees on behalf of Medicare Advantage Plans (MAPs) alleging that various primary payers have failed to reimburse MAP conditional payments allegedly giving rise to a Private Cause of Action under the Medicare Secondary Payer Act (MSP), specifically located at …
READ MORE

Blog, Legal/Legislative News, Medicare Advantage Part C, Medicare Jurisdiction, Medicare Secondary Payer News

Reprinted from the Morning Consultant In health policy, the minutia is not trivial; it’s essential. Small incentives created by policymakers can have a significant impact upon how Medicare beneficiaries, doctors, hospitals and insurers respond to health care claims. But sometimes policies — even the most well-intentioned — can have unintended consequences, leading to wasted resources, burdensome regulations and broken promises …
READ MORE

Blog, Medicare Reporting Section 111, ORM

In our oversight of numerous MMSEA Section 111 programs nationwide, we frequently answer many questions from clients surrounding Ongoing Responsibility for Medical (ORM). The confusion is understandable as ORM can be complicated. Let’s explore the various types of questions that we most often receive: What constitutes ORM? CMS defines ORM as a Responsible Reporting Entity (RRE)’s responsibility to pay for …
READ MORE

© 2012-2017 Franco Signor LLC