The Official Medicare Set Aside Blog And Information Resource

Establishing Appeal Rights for Applicable Plans – Presentation Now Available

CMS, Medicare Set-Aside Blog, MSP News on May 28, 2015 | Posted by Erin O'Neill, PA-C, JD

CMS has posted the slides from the May 5, 2015 webinar regarding the Appeals Rights for Applicable Plans. The presentation, entitled “Applicable Plan” Appeals: Appealing a Medicare Secondary Payer Recovery Claim where Medicare pursues recovery from insurers or workers’ compensation entities, is located in the Downloads Section of the Insurer Services What’s New page on […] Continue

New Section 111 COBSW URL Coming June 14, 2015

CMS, Medicare Set-Aside Blog on May 27, 2015 | Posted by Jessica M. Wingenroth, JD

On June 14, 2015, users of the Section 111 Coordination of Benefits Secure Website (COBSW) will be redirected to a new URL: https://www.cob.cms.hhs.gov/Section111/. Redirection will occur for 90 days, during which time users should transition to the new URL. CMS’ full technical alert is published under Downloads, via this link: http://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Mandatory-Insurer-Reporting-For-Non-Group-Health-Plans/NGHP-Alerts/NGHP-Alerts.html Continue

MSP vs PIP – Part 2

Commentary, Medicare Set-Aside Blog, MSP Litigation on May 21, 2015 | Posted by Jennifer Jordan, JD, MSCC

In April we saw our first MSP case involving a PIP carrier denying reimbursement responsibilities for medical benefits related to a covered auto accident that were paid by Medicare. [MSP RECOVERY, LLC v. PROGRESSIVE SELECT INSURANCE CO., 2015 U.S. Dist. LEXIS 47784 (Apr. 1, 2015)]. In that case, court found that plaintiff did “not allege […] Continue

CMS Webinar: Appeal Rights for Applicable Plans

CMS, Medicare Set-Aside Blog, MEDVAL News, MSP News on May 11, 2015 | Posted by Erin O'Neill, PA-C, JD

On Tuesday, May 5, 2015, CMS presented a webinar on the Appeal Rights for Applicable Plans. The final rule establishing a formal appeals process for applicable plans in situations where Medicare Secondary Payer Recovery is sought directly from an applicable plan, was effective on April 28, 2015. Barbara Wright began the call by explaining that […] Continue

Formal Appeal Rights for Conditional Payments for Applicable Plans

CMS, Medicare Set-Aside Blog, MSP News, News and Events on April 24, 2015 | Posted by Kimberly Wiswell

For Medicare Secondary Payer (MSP) recovery demand letters issued on or after April 28, 2015 to liability insurance (including self-insurance), no-fault insurance, or a workers’ compensation entity as the debtor, these entities will now have formal appeal rights. On February 27, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a final rule implementing […] Continue

RAC Program Revisions Necessitate Appeals Process Review

Commentary, Medicare, Medicare Set-Aside Blog on April 21, 2015 | Posted by Gwendolyn Hauck

In 2013, almost $4 billion in improper Medicare payments were identified and returned.[1] This staggering number can be attributed to the work of the Recovery Audit Program. The Recovery Audit Program was initially authorized by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 in an effort to facilitate cost-effective enforcement of the myriad […] Continue

What Constitutes “Demonstration of Responsibility” in a PIP Claim?

Commentary, Medicare Set-Aside Blog, MSP Litigation on April 14, 2015 | Posted by Jennifer Jordan, JD, MSCC

My understanding of PIP is that it pays regardless of fault.  In fact, Progressive Insurance’s website states:  “PIP Insurance pays for your personal medical expenses or for injuries sustained by your passengers – no matter who is at fault for the accident.”   It is also my understanding that in Florida, PIP subrogation is generally prohibited […] Continue

New MMSEA Section 111 NGHP User Guide, Version 4.6, Released 04/06/2015

CMS, Medicare Set-Aside Blog on April 7, 2015 | Posted by Jessica M. Wingenroth, JD

The newest installment of the NGHP User Guide incorporates data issued in CMS’ 11/25/14 Technical Alert regarding the reporting of partial SSNs. As you may recall, the Alert provided detailed instruction as to what action an RRE should take when Disposition Code “DP” (duplicate) is returned. Disposition Code “DP” is returned when there are multiple […] Continue

CMS to Begin Utilizing 2010 Life Table

CMS, Medicare Set-Aside Blog on March 2, 2015 | Posted by Jean S. Goldstein, JD

CMS issued a notification on the CMS website that as of April 1, 2015, CMS will begin referencing CDC’s Table 1: Life table for the total population: United States, 2010, (Vol. 63, No. 7) for WCMSA life expectancy calculations. This means that for any WCMSA proposal received by CMS, or where any WCMSA case is […] Continue

Medicare Beneficiary Sues “CSM Medicare Set-Aside Philiphidia” for Abuse

CMS, Commentary, Medicare Set-Aside Blog on February 23, 2015 | Posted by Jennifer Jordan, JD, MSCC

On February 18, 2015, the US District Court for the District of Columbia dismissed a pro se civil complaint filed by a resident of Waldorf, MD formerly employed by Securiguard, Inc. Ms. Treakle settled her 1999 work injury in 2006 for $252,269.37, from which she was required to set-aside only $15,456.00 as an MSA. Ms. […] Continue