The Official Medicare Set Aside Blog And Information Resource

CMS May Finally Be Forced to Address Medicare Appeal Backlog

CMS, Commentary, Medicare, Medicare Set-Aside Blog, MSP News on February 10, 2016 | Posted by Jennifer Jordan, JD, MSCC

On Tuesday, February 9, 2016, the U.S. Court of Appeals for the District of Columbia overturned the December 2014 dismissal of a suit by the American Hospital Association against DHHS for unreasonable delays in processing RAC appeals. At the time the lower court ruled that the delay wasn’t unreasonable enough to elicit an order from […] Continue

CMS Considering IMR Determinations More Favorably

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, State Regulations on February 5, 2016 | Posted by Jean S. Goldstein, JD

An interesting and exciting turn of events has occurred within the last week, and we are pleased to report that we have begun to notice a change in the manner by which CMS is considering Independent Medical Review determinations (IMRs).  Over the last two years, MEDVAL has played an instrumental role in assisting in educating […] Continue

Updates Added to the WCMSA Reference Guide

CMS, Medicare Set-Aside Blog, MSA Administration on February 1, 2016 | Posted by Jean S. Goldstein, JD

An updated and revised WCMSA reference guide has been issued. The revised guide, version 2.4, can be found here. The revised WCMSA reference guide only has one update, which specifically addresses ongoing responsibility for medicals (ORM) recovery activities.  Specifically, the updated guide notes that “[i]f Medicare is pursuing recovery from the WC insurer, the beneficiary, […] Continue

Takemoto False Claims Act Suit Finally Dismissed with Prejudice

Medicare Set-Aside Blog, MSP Litigation on January 22, 2016 | Posted by Jennifer Jordan, JD, MSCC

For anyone following the ongoing saga of Kent Takemoto’s final attempt to cash in on the insurance industry’s obligations to Medicare, we have finally reach the conclusion. On January 20, 2016, the U.S. District Court for the Western District of New York accepted the magistrate judge’s recommendations and dismissed the suit with prejudice, at least […] Continue

Supreme Court Provides Argument Against Post-Settlement Bass Boat Purchases

Commentary, Fraud, Medicare, Medicare Set-Aside Blog, MSP Litigation on January 20, 2016 | Posted by Jennifer Jordan, JD, MSCC

We joke quite regularly about how quickly settlement funds will disappear and what will be bought. Well the Supreme Court today may have just made that less amusing for plaintiffs. In an 8-1 decision, the United States Supreme Court prevented an ERISA plan from recovering from a plaintiff who settled a third-party claim for $500,000 […] Continue

Enhanced Functionality and Other Changes to the Medicare Secondary Payer Recovery Portal as of January 1, 2016

CMS, Conditional Payments, Mandatory Insurer Reporting, Medicare, Medicare Set-Aside Blog, MSP News on January 6, 2016 | Posted by Erin O'Neill, PA-C, JD

As of January 1, 2016, the Medicare Secondary Payer Recovery Portal (MSPRP) now includes functionality for obtaining a final conditional payment amount on those cases that are 120 days or less from an anticipated settlement. These changes were implemented as part of the Strengthening Medicare and Repaying Taxpayers Act of 2013. Authorized users are now […] Continue

CMS Issues Reminder Regarding Accurate Reporting of ICD-9 and ICD-10 codes for Ongoing Responsibility for Medicals (ORM)

CMS, Conditional Payments, Mandatory Insurer Reporting, Medicare, Medicare Set-Aside Blog on December 29, 2015 | Posted by Erin O'Neill, PA-C, JD

CMS has indicated that effective January 1, 2016, claims processing contractors will begin to utilize information provided by workers’ compensation entities/insurers for the purpose of reporting Ongoing Responsibility for Medicals (ORM), to determine whether Medicare is able to make primary payment for those claims. As they have done in the past, CMS emphasizes the importance […] Continue

Personal Injury Attorney Suspended for Poor Handling of Medicare Conditional Payment Reimbursement

Conditional Payments, Medicare, Medicare Set-Aside Blog, MSP Litigation on December 7, 2015 | Posted by Jennifer Jordan, JD, MSCC

Anyone can resolve a Medicare reimbursement. You don’t need to be a lawyer or MSP specialist. But the reason companies like ours exist is because CMS doesn’t make it easy. If you do not know how to navigate the process, it could take a long time. You may contact the wrong contractor and not receive […] Continue

Mary Reale’s Six Year Medicare Part C Saga Continues

Medicare Set-Aside Blog, MSP Litigation on December 3, 2015 | Posted by Jennifer Jordan, JD, MSCC

In the ongoing saga as to whether Medicare Advantage actually has the same recovery rights as the federal government when it comes to Medicare conditional payments, the Court of Appeals of Florida has determined that the underlying state court in Humana v. Reale lacked subject matter jurisdiction in determining an MAO’s reimbursement rights. This decision […] Continue

Upcoming Enhancement to the Functionality of the Medicare Secondary Payer Recovery Portal

CMS, Conditional Payments, Mandatory Insurer Reporting, Medicare, Medicare Set-Aside Blog on November 13, 2015 | Posted by Erin O'Neill, PA-C, JD

The Centers for Medicare and Medicaid Services (CMS) has announced that the Medicare Secondary Payer Recovery Portal (MSPRP) will be updated to include functionality for obtaining a final conditional payment amount on those cases that are 120 days or less from an anticipated settlement. As part of the Strengthening Medicare and Repaying Taxpayers Act of […] Continue