CMS Announces Intent to Enhance Re-Review Process in 2017

11 Jan 2017 Heather Sanderson No Comments

Blog, Medicare Set Aside, WCMSA

Yesterday, CMS issued an Alert which states the following (the alert can be found here): The Centers for Medicare & Medicaid Services recently revisited the task of reviewing its process for addressing requests for CMS to “re-review” otherwise approved Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) amounts. In Calendar year 2017, CMS expects to update its existing re-review process to address …
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Blog, Medicare Secondary Payer News, Medicare Set Aside, WCMSA

We recently blogged that CMS delayed the Workers’ Compensation Review Contractor (the entity that reviews Workers’ Compensation Medicare Set-Asides) award to the 2ndquarter of 2017, with the solicitation being released in the 1st quarter. For our prior blog, click here. CMS has now released their draft Request for Proposal (RFP) as well as draft Statement of Work (SOW) for the Contractor.  While it is …
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Blog, Medicare Set Aside, WCMSA

According to the Court of Appeals of North Carolina, a WCMSA was not considered a “countable resource” for purposes of determining a claimant’s Medicaid eligibility, Williford v. North Carolina Department of Health and Human Services, 2016 N.C. App. LEXIS 1163 (November 15, 2016). The basic facts of the case involve a 68-year-old widow (Ms. Williford), who suffered a work injury …
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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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Blog, Medicare Jurisdiction, Medicare Secondary Payer News

A few months ago, we issued a blog regarding MSP private cause of action litigation against a Plaintiff attorney law firm for failure to reimburse the MAP its conditional payments (Humana v. Paris Blank LLP). For our prior blog on this case, click here. The Paris Blank matter has now settled and the parties are subject to a confidentiality provision.  …
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CMS Rescinds Recent Changes to Review of Zero Allocations

04 Nov 2016 Heather Sanderson No Comments

Blog, Legal/Legislative News, Medicare Set Aside

Last week, the Workers’ Compensation Review Contractor (WCRC) informally let the industry know that an internal quality review revealed that the WCRC was improperly applying CMS’ documentation requirements to the review of zero allocations in denied worker’s compensation claims. As such, additional documentation would now be required for the WCRC to issue an approval of a zero Medicare Set-Aside (MSA) …
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