Blog, LMSA, Medicare Set Aside

It was bound to happen.  When legal responsibility exists to comply with a law, but no policy or procedure is in effect as to how, parties to a liability case will fashion their own solution.  That’s exactly what took place in Big R Towing, Inc. v. David Wayne Benoit, et al,  2011 U.S. Dist. LEXIS 1392 where the court was …
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Ninth Circuit Disagrees with Bradley v. Sebelius

05 Jan 2011 Roy Franco No Comments

Blog, Medicare Conditional Payments, Reimbursements

Recently, the Nevada Federal District Court in Farmers Insurance Exchange v. Leona Forkey 2010 U.S. Dist. LEXIS 137716 upheld the Ninth Circuit’s position in Zinman v. Shalala, 67 F.3d 841 (9th Cir. 1995) that Medicare’s reimbursement claim for conditional payments takes precedence over the claims of any other party.  Citing the Medicare Secondary Payer Manual as authority for its position, …
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Blog, Medicare Conditional Payments, Reimbursements

By Jeff Signor & Roy Franco Surprised? We are not. To alleviate the contingent liabilities created by the Medicare Secondary Payer Act (MSPA) parties must cooperate. Without cooperation on the Medicare topic, there will be more decisions like Zaleppa v. Seiwell, 2010 PA Super 208 (11/17/2010). The MSPA is designed to protect the Medicare beneficiary. Therefore, primary plans cannot deprive …
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Blog, Medicare Set Aside, WCMSA

By Alvena Ferreira, RN, CCM, CNLCP, MSCC and Katie A. Fox, MSCC Effective December 1, 2010, the New York State Worker’s Compensation Board will implement medical treatment guidelines for injuries to the neck, mid and low back, shoulder, and knee. The guideline documents state that these were developed in part from the State of Colorado’s guidelines and ACOEM guidelines. The …
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Blog, Medicare Reporting Section 111, ORM, TPOC

By Katie A. Fox, MSCC Last Friday, the Centers for Medicare & Medicaid Services (CMS) issued an alert extending the mandatory reporting period for Liability cases with a Total Payment Obligation to Claimant (TPOC) only.  We wrote yesterday about the positive effect this would have on the liability industry struggling to get its data systems ready for reporting.   However, the alert also …
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CMS EXTENDS MANDATORY REPORTING FOR LIABILITY CASES

15 Nov 2010 Roy Franco No Comments

Blog, Medicare Reporting Section 111, ORM, RRE, TPOC

Franco Signor LLC – November 15, 2010 Centers for Medicare and Medicaid Services (CMS) issued new liability reporting rules in an alert on November 9, 2010. Click here for the Alert.  Responsible Reporting Entities (RRE) may now voluntarily report liability settlements, awards and judgments, without penalty, beginning next year. Mandatory liability reporting is now slated to start January 1, 2012, …
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