The Official Medicare Set Aside Blog And Information Resource

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

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