Blog, Medicare Conditional Payments, Reimbursements

In a split decision, the 6th Circuit Court of Appeals recently held that Medicare’s right to be completely repaid for medical items and services related to a personal injury claim could not be decreased based upon principles of fault.  See Hadden v. U.S., 2011 U.S. App. LEXIS 23289, (6th Cir. November 21, 2011). The 6th Circuit’s decision should be appealed …

Medicare Reporting Section 111, ORM, WCMSA

Katie A. Fox, MSCC – October 21, 2011 The much awaited Version 3.2 of the User Guide was released on August, 17, 2011. The User Guide outlines several changes, but hidden in section 11.8 is a process to manually terminate the ORM status between Section 111 claim detail electronic submissions.  Throughout the industry the subsequent memorandums have gained much publicity, …

CMS Updates MSP Compliance for Liability Claims

03 Oct 2011 Jeff Signor No Comments

Blog, LMSA, Medicare Secondary Payer News, Medicare Set Aside

This memo is consistent with our article about the LMSA and confirms the roadmap we have in place for our clients. We are now working on a form letter to put before the treating doctor to execute. If this letter cannot be secured, we recommend following our roadmap to make certain Medicare’s interests are properly protected. Cooperation of the plaintiff and his/her representative will be key. However, the memo should improve cooperation in this regard.

Blog, LMSA, Medicare Set Aside

  The Centers for Medicare & Medicaid Services (CMS) has put the insurance industry on high alert. Threat of penalties for failure to report liability claims involving a Medicare beneficiary has raised concerns over properly meeting obligations owed Medicare.  One particular question has raised  great controversy – Does a settlement, judgment, award, or other payment to a Medicare beneficiary need …

Blog, Medicare Secondary Payer News

Founding co-chairs, Roy Franco and Katie A. Fox, are excited to witness the future evolution of the MSP reform process.

Blog, Medicare Jurisdiction

We’ve written on the difficulty in obtaining jurisdiction against Medicare multiple times. Recently, a U.S. District Court denied the Government’s motion to dismiss a state lawsuit against it for lack of subject matter jurisdiction and the case was remanded back to state court for further proceedings. Although an apparent victory for establishing jurisdiction against the Government, it remains to be …

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