Category Archives: LMSA

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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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, 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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Administration, Blog, LMSA, Medicare Set Aside, WCMSA

As a follow-up to our recent blogs regarding a change in the Workers’ Compensation Review Contractor (WCRC) and the new WCRC reviewing Liability Medicare Set-Asides (LMSAs), CMS has now released the official solicitation for the award. The solicitation can be found here, and our latest prior blog on this topic can be found here. The solicitation states that proposal bids are due …
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CMS Reduces MSP Liability Threshold for 2017 to $750

05 Dec 2016 Heather Sanderson No Comments

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

Yesterday, CMS announced that the threshold for liability settlements will reduce to $750. CMS will also maintain the $750 threshold for no-fault and workers’ compensation settlements, where the no-fault insurer or workers’ compensation entity does not otherwise have ongoing responsibility for medicals. To read CMS’ Alert click here. For CMS’ methodology in determining its 2017 thresholds, click here. Recall that …
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LMSA, Medicare Conditional Payments, Medicare Set Aside

A recent opinion out of the Eastern District of New York, Sexton v. Medicare, 2016 U.S. Dist. LEXIS 89815 (July 11, 2016), found that a Plaintiff cannot refute or defeat Medicare’s ability to recover conditional payments until the primary payer has demonstrated responsibility through a settlement, judgment or award. The brief facts involved Plaintiff Kevin Sexton (“Plaintiff”) being struck by …
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CMS Considering LMSA Review Process

10 Jun 2016 Heather Sanderson No Comments

Blog, LMSA

CMS issued an Alert yesterday which states: The Centers for Medicare and Medicaid Services (CMS) is considering expanding its voluntary Medicare Set-Aside Arrangements (MSA) amount review process to include the review of proposed liability insurance (including self-insurance) and no-fault insurance MSA amounts. CMS plans to work closely with the stakeholder community to identify how best to implement this potential expansion. …
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Blog, LMSA, Trial Practice

Legal Practitioners continue to seek guidance from Courts in absence of Centers for Medicare & Medicaid Services (CMS) rules on how to protect Medicare’s interest in a liability settlement.  We field calls every day from frustrated attorneys and claim handlers because of their concern about taking the right action to protect Medicare’s interests post-settlement.  CMS’ withdrawal of the NPRM on …
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Blog, LMSA, Medicare Secondary Payer News

Click here to read the recent Computation of Annual Liability Insurance (Including Self-Insurance) Settlement Recovery Threshold report that was submitted to the Congress pursuant to Section 202 of the SMART Act.

Blog, LMSA, Medicare Set Aside

Last week the Centers for Medicare & Medicaid Services (CMS) withdrew its proposed regulation for future medicals with respect to liability claim settlements. The Notice of Proposed Rulemaking (NPRRM) was submitted to the Office of Management & Budget over a year ago on August 1, 2013. The CMS submission can be found here. The NPRM was expected to cover how …
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