The Official Medicare Set Aside Blog And Information Resource

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

Courts Can Only Enforce the Law, Making MSAs Tricky at TImes

Commentary, Liability, Medicare Set-Aside Blog, Medicare Set-Asides, MSP Litigation on February 12, 2015 | Posted by Jennifer Jordan, JD, MSCC

The most important thing you can do in any settlement involving a Medicare beneficiary is thoroughly memorialize the measures taken to protect Medicare’s interests. Vague mention in passing can lead to settlements blowing up or one of the parties not receiving what it bargained for. Take for example a recent Second Circuit Court of Appeals […] Continue

NGHP User Guide Version 4.5 Released with New Policy Language Concerning Exposure, Ingestion, and Implantation Claims and December 5, 1980

CMS, Medicare Set-Aside Blog on February 3, 2015 | Posted by Jessica M. Wingenroth, JD

The newest version of the NGHP User Guide was released on February 2, 2015, and contains new policy language in Chapter III: Policy Guidance. Section 6.5.1, entitled What Claims Are Reportable? When Are Such Claims Reportable?, addresses the fact that RREs are not required to report liability or no-fault insurance settlements, judgments, awards or other […] Continue

NGHP Mandatory Insurer Reporting Reminder: ICD-10-CM Diagnosis Codes Coming Soon, 10/01/15

CMS, Medicare Set-Aside Blog, MEDVAL News on January 29, 2015 | Posted by Jessica M. Wingenroth, JD

In a Technical Alert dated January 28, 2015, CMS issued a reminder that October 1, 2015 is the date to remember for reporting ICD-10-CM diagnosis codes, but for most RREs, testing can be completed now. Prior to October 1, 2015, RREs are encouraged to submit test files with ICD-10-CM diagnosis codes, but for actual reporting, […] Continue

Louisiana Court Approves Zero Set Aside in Product Liability Settlement

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

Louisiana courts continue to lead the nation in opining on MSA issues. In a declaratory judgment rendered this week, the court found that plaintiff had presented sufficient evidence from his treating physicians (one of which was a dentist) to demonstrate that he required no further treatment related to a car accident for which he blamed […] Continue

Bankruptcy Court Declares WCMSAs are a “Trust”

CMS, Commentary, Medicare Set-Aside Blog, Medicare Set-Asides, MSP Litigation on January 7, 2015 | Posted by Jennifer Jordan, JD, MSCC

I have been waiting for over seven years since In re Sanchez for another bankruptcy court to tell us whether or not MSA funds would be excluded assets in bankruptcy. Today I finally found out that they are not, but the point is kind of irrelevant. According to the US Bankruptcy Court for the Middle […] Continue

CMS Releases MMSEA Section 111 NGHP User Guide Version 4.4

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

CMS released an updated NGHP User Guide, Version 4.4, dated January 5, 2015. The primary changes include: The TPOC Liability Claim Report Rejection code CJO7 changed in definition so that cumulative liability TPOC reports of amounts less than or equal to $1,000, with no ORM, will be rejected. The prior NGHP User Guide had indicated […] Continue

Updates Added to the WCMSA Reference Guide

CMS, Medicare Set-Aside Blog, MSP News on January 7, 2015 | Posted by Jean S. Goldstein, JD

CMS issued an alert today that a revised version of the WCMSA reference guide has been released.  The revised guide, dated January 5, 2015, can be found here. CMS also issued a revised Self-Administration Toolkit for WCMSAs, which can also be found here.  The Self-Administration Toolkit serves as a helpful resource for Claimants and provides […] Continue

Crosstalk Between Implantable Devices

CMS, Medicare Set-Aside Blog, Medicare Set-Asides on December 30, 2014 | Posted by Jennifer Jordan, JD, MSCC

I recently stumbled across an interesting opinion out of the 6th Circuit Court of Appeals upholding a Medicare coverage determination denying the implantation of an infusion pump. The Medicare beneficiary in question suffered from chronic low back pain for over 20 years and was using high doses of multiple pain medications and a spinal cord […] Continue