Category Archives: Medicare Set Aside

Blog, LMSA, Medicare Secondary Payer News, Medicare Set Aside, WCMSA

Liability Medicare Set-Asides (LMSAs) and No-Fault Medicare Set-Asides (NFMSAs) Update – The Centers for Medicare and Medicaid Services (CMS) has been taking incremental steps recently to implement a review process for LMSAs and NFMSAs. Over the past year we saw a series of indications that CMS was looking to implement a review process.  The Request for Proposal (RFP) for the Workers’ Compensation …
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Blog, Medicare Set Aside, WCMSA

Back in November of 2016, we blogged regarding the Workers’ Compensation Review Contractor (WCRC) introducing more stringent requirements for CMS approval of a zero Workers’ Compensation Medicare Set-Aside (WCMSA). For a short period of time, the WCRC was requiring either a court order or treating physician statement to approve a zero MSA allocation. However, the WCRC retracted this policy just …
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Blog, Legal/Legislative News, Medicare Secondary Payer News, WCMSA

The WCRC, the entity which reviews Workers’ Compensation Medicare Set-Asides (WCMSAs) for the Centers for Medicare & Medicaid Services (CMS) has issued the award to Capitol Bridge LLC, a government services firm with its headquarters in Arlington, Virginia. The award notice is as of September 1, 2017 and can be found here. Noteworthy of the award is that it is for …
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Blog, Medicare Jurisdiction, Medicare Secondary Payer News, WCMSA

The Centers for Medicare & Medicaid Services (CMS) issued an updated Workers’ Compensation Medicare Set-Aside (WCMSA) Reference Guide on July 31st, although the Reference Guide is dated July 10, 2017. There are several important changes to note within this new Reference Guide (the new Guide can be located here). We have listed the more noteworthy changes first: Updated Amended Review …
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Legal/Legislative News, Medicare Jurisdiction, Medicare Set Aside, WCMSA

There are two recent updates which may impact workers’ compensation payers looking to finalize and foreclose future medical expenses and which additionally may impact claims that involve a Medicare Set-Aside (MSA). I. Arizona Passes Bill 1332 Allowing for Full and Final Settlement of Workers’ Compensation Claims Senate Bill 1332, signed into law by Governor Ducey on May 8, 2017 which …
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Blog, Medicare Jurisdiction, Medicare Set Aside, WCMSA

The Centers for Medicare & Medicaid Services (CMS) has followed through on their previously announced intent to expand their Medicare Set-Aside (MSA) Re-Review process. For our prior blog on CMS’ January announcement that it intended to expand its re-review process in 2017, click here. For those that need a refresher on CMS’ MSA Re-Review process, where an MSA is submitted …
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The Grinding Gears of CMS Regulation

27 Jun 2017 John Williams No Comments

Blog, Franco Signor News, Legal/Legislative News, Medicare Conditional Payments, Medicare Reporting Section 111, Medicare Secondary Payer News, Medicare Set Aside

The Grinding Gears of CMS Regulation A CLM Magazine Article by John Williams and Heather Sanderson Personal Injury and No-Fault Payers Should be Aware of Three Compliance Issues  As the Centers for Medicare and Medicaid Services (CMS) faces mounting pressure to address financial challenges, the agency is looking for methods to recover over-payments and ensure that it does not make a …
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Expanded Recoveries on the Horizon

12 Apr 2017 John Williams No Comments

About Franco Signor, Blog, Franco Signor News, LMSA, Medicare Conditional Payments, Medicare Secondary Payer News

In a recent blog, Heather Sanderson highlighted the success of MSP Recovery LLC (Plaintiff) certifying a class of Florida Medicare Advantage Organizations (MAOs) that had claims where a non-group health plan (NGHP) failed to make primary payment.   In the filings, the Plaintiff is indicating that they have access to data from the Defendant, MAO, DMV, ISO, and CMS.   With this …
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Blog, Legal/Legislative News, Medicaid Third Party Liability Recoveries, Medicare Jurisdiction, Medicare Secondary Payer News, Medicare Set Aside

A Complaint has been filed in the State of Utah by its Attorney General to force four of its largest asbestos bankruptcy trusts to comply with civil investigative demands (CIDs) seeking information regarding whether the trusts were failing to reimburse Medicare and Medicaid for medical expenditures. The Complaint was filed March 7th in Salt Lake City. A copy of the …
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Blog, LMSA, Medicare Set Aside

CMS recently issued documentation signaling that Liability Medicare Set-Asides (LMSAs) and No-Fault Medicare Set-Asides (NFMSAs) will be notated fields in CMS’ Common Working File (CWF). Effective October 1, 2017, Medicare Administrative Contractors (MACs) will begin denying payment for services associated with an open LMSA or NFMSA record. The CMS Manual Update can be found here, and the MLN Matters alert …
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