Category Archives: Medicare Secondary Payer News

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

The Medicare Advocacy Recovery Coalition (MARC) has announced that the Provide Accurate Information Directly (PAID) Act was introduced yesterday, February 27, 2019 in the U.S. House of Representatives as H.R. 1375 by lead Co-Sponsors Reps. Ron Kind (D-WI) and Gus Bilirakis (R-FL). Representatives Kind and Bilirakis have sponsored this bipartisan legislation to improve the Medicare Secondary Payer Act (MSP). PAID’s …

Blog, Legal/Legislative News, Medicaid Third Party Liability Recoveries, Medicare Secondary Payer News

The following article was co-written by: Roy Franco, Chief Client Officer and Matthew Newman, Associate Compliance Counsel A U.S. District Court’s ruling regarding MSP Recovery LLC’s recent filings in State Court has raised concerns about a possible Medicaid Third Party Liability recovery strategy.  The situation involves an archaic discovery mechanism (“bill of pure discovery”) that would allow MSP Recovery LLC …

Blog, Medicare Reporting Section 111, Medicare Secondary Payer News, RRE

The Centers for Medicare & Medicaid Services (CMS) has issued yet another abundantly clear signal that Medicare Secondary Payer (MSP) enforcement will be a priority in 2019. Just last week, we blogged that a Proposed Rule on a voluntary review process for Liability Medicare Set-Asides (LMSAs) would be issued by September 2019. Now, an additional notice on the Office of Management and …

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 …

Blog, Medicare Secondary Payer News, Pharma Part D

Recently, CMS updated its Part D Manual to include specific changes to the Manual’s Medicare Secondary Payer (MSP) provisions.  The updated manual can be found here. Page 40 now provides: “Part D sponsors are responsible for adjudicating enrollees’ claims in accordance with MSP requirements. Under CMS’ adjudication logic for Part D MSP claims, the provider/pharmacy receives at least the Part …

Blog, Legal/Legislative News, Medicare Advantage Part C, Medicare Jurisdiction, Medicare Secondary Payer News

Reprinted from the Morning Consultant In health policy, the minutia is not trivial; it’s essential. Small incentives created by policymakers can have a significant impact upon how Medicare beneficiaries, doctors, hospitals and insurers respond to health care claims. But sometimes policies — even the most well-intentioned — can have unintended consequences, leading to wasted resources, burdensome regulations and broken promises …

About Franco Signor, Blog, Medicaid Third Party Liability Recoveries, Medicare Secondary Payer News

Originally published in the June 2018 Issue of CLM Magazine TIME TO GET PAID In 1965, President Johnson signed into law the Medicaid program, establishing the state-based healthcare safety net system in place today. Although since that time Congress has undertaken dozens of efforts to streamline and improve Medicaid, historically there has not been considerable focus to improve states’ Medicaid …

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 …

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 …

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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