The Official Medicare Set Aside Blog And Information Resource

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

Typo in Settlement Document (& Greed) Leads to Claimant’s Loss of MSA Funding

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

Mistakes happen. This would not be the first time I’ve seen the word monthly substituted for annually in a settlement document involving a structured settlement. But what makes this case interesting is that the claimant actually lost all of his annuity payments when he tried to enforce the express terms of the settlement agreement. And […] Continue

LexisNexis Top Blogs for Workers’ Compensation and Workplace Issues – 2014 Honorees: MEDVAL, LLC

Medicare Set-Aside Blog, News and Events on December 22, 2014 | Posted by Kimberly Wiswell

Appearing for our sixth consecutive year on the LexisNexis Top Blogs for Workers’ Compensation and Workplace Issues honorees list is our blog, “The Official Medicare Set Aside Blog and Information Resource”. As 2014 draws to a close, the LexisNexis Legal Newsroom Workers’ Compensation combed through more than 200 blog sites that cater to the workers’ […] Continue

New announcement regarding Hydrocodone combination product coverage changes in Medicare Part D effective for WCMSA proposals

CMS, Medicare Set-Aside Blog, Rx/Pharmacy on November 19, 2014 | Posted by Jean S. Goldstein, JD

On November 19, CMS issued an alert regarding a CMS trend we have been seeing more frequently as related to more frequent physician visits.  The alert specifically refers to action taken by the U.S. Drug Enforcement Administration regarding rescheduling of hydrocodone combination products from C-III controlled substances to C-II controlled substances.  Based on this classification, […] Continue

What’s Good for the Goose… MSAs the Federal Government’s Way

Commentary, Medicare Set-Aside Blog, Medicare Set-Asides, MSP Litigation on November 17, 2014 | Posted by Jennifer Jordan, JD, MSCC

An interesting longshore case involving an MSA was recently reported out of Oregon. Claimant Phillip Tucker was hurt on a vessel owned by the United States and being serviced at Cascade General, Inc., the plaintiff’s employer. Tucker filed suit against both and then each of them filed cross-claims against each other. Tucker’s wife had filed […] Continue

MMSEA Section 111 Alert: CMS to Allow NGHP RREs to Designate a Medicare Secondary Payer Recovery Agent through Mandatory Insurer Reporting, July 2015

CMS, Medicare Set-Aside Blog, MSP News on November 14, 2014 | Posted by Jessica M. Wingenroth, JD

The current “TPA workaround” method of identifying a third party administrator on TIN Reference files is being eliminated. CMS has announced that effective 07/13/15, NGHP RREs will have the option to designate an MSP Recovery Agent with whom they wish to share copies of all correspondence related to conditional payments and recovery demands. The RRE […] Continue