Category Archives: Medicare Secondary Payer News

Blog, Medicare Advantage Part C, Medicare Conditional Payments, Medicare Secondary Payer News, Trial Practice

As we have noted in numerous recent blogs, Medicare Secondary Payer (MSP) Private Cause of Action litigation has been on the rise and has grown to be incredibly rampant in the past several years. Innate to this recently popular weapon for double damages against primary plans is the unfortunately vague and ambiguous language in the MSP defining the action. The …
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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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CMS Releases Updated NGHP User Guide Version 5.3

27 Dec 2017 Heather Sanderson No Comments

Blog, Legal/Legislative News, Medicare Conditional Payments, Medicare Reporting Section 111, Medicare Secondary Payer News

CMS has released an updated Non-Group Health Plan (NGHP) User Guide version 5.3. It can be found here. The primary change to the User Guide involves detailing CMS’ transition with its Social Security Number Removal Initiative (SSNRI) and how this transition will impact MMSEA Section 111 Reporting. The SSNRI initiative mandates CMS to replace all SSN-based Medicare identifiers and distribute a …
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Blog, Medicare Conditional Payments, Medicare Secondary Payer News, TPOC

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. Last year in 2016, CMS announced that the threshold would be $750 across all non-group health plan (NGHP) lines of business- workers’ compensation, liability, and no-fault insurance. The threshold means that if the …
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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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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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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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About Franco Signor, Franco Signor News, Medicaid Third Party Liability Recoveries, Medicare Secondary Payer News

Medicare Advantage Plans, LMSA/NFMSAs, and Medicaid Recovery Rights: What’s on the Horizon?  Medicare Advantage plans are continuing to litigate nationwide to assert their rights to double damages for unreimbursed conditional payments. Class actions are being certified by MAOs to assert these rights against primary payers. CMS is taking steps announced plans toward establishing a voluntary review process for LMSAs and …
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