Category Archives: Medicare Set Aside

About Franco Signor, Administration, Blog, Legal/Legislative News

BRADENTON, Fla., April 1, 2019 /PRNewswire/ — Franco Signor announced today its new Post-Settlement Administration Services. The service platform is available to injured parties at www.CareMDRx.com. This new platform is designed for individuals that have settled their workers’ compensation or personal injury case and have future medical care needs. Post-Settlement Administration Services are commonly used by individuals who may be …
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CMS Updates WCMSA Reference Guide and NGHP User Guide

09 Jan 2019 Heather Sanderson No Comments

Blog, Medicare Set Aside, WCMSA

Yet another indication that The Centers for Medicare & Medicaid Services (CMS) intends to make Medicare Secondary Payer (MSP) enforcement a priority in 2019: both the WCMSA Reference Guide and NGHP User Guide have been updated with several impactful changes. The updated WCMSA Reference Guide can be found here, and the updated NGHP User Guide can be found here. WCMSA …
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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 …
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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 …
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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: …
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Administration, Blog, Legal/Legislative News, Medicare Set Aside, WCMSA

For numerous years, a slightly varied version of essentially the same proposed legislation regarding Workers’ Compensation Medicare Set-Asides (WCMSAs) continues to be re-introduced in Congress (hereinafter referred to as “MSA Bill”). Just last week, the MSA Bill was again introduced in the Senate. It is titled “Medicare Secondary Payer and Workers’ Compensation Settlement Agreements Act of 2018.” A copy of …
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Settlement Contingent Upon CMS Approval of WCMSA: Problematic?

08 May 2018 Heather Sanderson No Comments

Blog, Legal/Legislative News, Medicare Secondary Payer News, WCMSA

A decision just issued out of the Third Circuit Court of Appeal in Louisiana demonstrates the various nuances and obstacles that may be present when entering into a workers’ compensation settlement contingent upon CMS approval of a WCMSA. In Ortega v. Cantu Servs., Inc. 2018 La. App. LEXIS 845 (May 2, 2018), the claimant, a Medicare beneficiary, settled her disputed …
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Blog, Medicare Set Aside, WCMSA

Version 2.7 of the Workers’ Compensation Medicare Set-Aside (WCMSA) Reference Guide has been released as of March 19, 2018. It can be found here. The two minor changes are the following: An updated phone number for the Workers’ Compensation Review Contractor (WCRC). The new phone number is (833) 295-3773. See section 14.0 (pg. 51), Appendix 1 (pg. 61) and Appendix 5 (pg. 84). …
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Blog, Medicare Secondary Payer News, WCMSA

Yesterday, March 7th, the Centers for Medicare & Medicaid Services (CMS) conducted a webinar to discuss the transition of the new Workers’ Compensation Review Contractor (WCRC) from Provider Resources to Capitol Bridge LLC. Below is a summary of the relevant points of the webinar.  Timing of Transition: Capitol Bridge LLC will fully take over on March 19, 2018. New Contact Information: The …
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About Franco Signor, Blog, LMSA, Medicare Secondary Payer News

This article was originally published in the March 2018 issue of CLM Magazine. A CMS Framework is Coming – Are You Involved?  (A CLM Magazine Article by Roy Franco and Heather Sanderson) For many years, Liability Medicare Set-Asides (LMSAs) have been a hot topic for discussion due to the potential challenges that a Centers for Medicare & Medicaid Services’ (CMS) LMSA review …
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