Category Archives: LMSA

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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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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About Franco Signor, LMSA

Click here to register to view the recording. Join Roy Franco and Heather Sanderson for their first live/video webinar event on January 31st at 1:30 PM EST. Roy and Heather will be taking on the hot topic of LMSAs, and what payers should be doing right now to gear up for the likelihood of CMS introducing a review policy for …
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Blog, Legal/Legislative News, LMSA, Medicare Conditional Payments, Medicare Set Aside, WCMSA

The United States District Court for the District of New Mexico has issued an interesting decision involving the uncertainty for the need of a Liability Medicare Set-Aside (LMSA) in a medical malpractice settlement involving a Medicare beneficiary. The case is captioned Silva v. Burwell, 2017 U.S. Dist. LEXIS 195032 (November 28, 2017). A copy of the decision can be found …
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Blog, LMSA, Medicare Set Aside

Liability Medicare Set-Asides (LMSAs) and No-Fault MSAs (NFMSAs) Update: We recently issued a blog that CMS withdrew/rescinded a MedLearn article to medical providers which directed medical providers to bill a LMSA/NFMSA where a Medicare beneficiary has received a Medicare Set-Aside as part of a liability, no-fault or workers’ compensation settlement, judgment or award (instead of Medicare).  While the MedLearn article …
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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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