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 …
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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, 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 …
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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 Conditional Payments, Medicare Jurisdiction

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. For the last two years 2017-2018, CMS has maintained the threshold of $750 across all non-group health plan (NGHP) lines of business- workers’ compensation, liability, and no-fault insurance. The threshold means that if …
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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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