The Official Medicare Set Aside Blog And Information Resource

Section 111 NGHP User Guide Version 4.3, Revised to Implement Eight Change Requests, Primarily Related to ICD-10 Coding

Medicare Set-Aside Blog, MSP News on October 9, 2014 | Posted by Jessica M. Wingenroth, JD

According to the Revision History, Version 4.3 of the NGHP User Guide applies more changes than any other update in the 5+ years since Version 1.0 was published.  A majority of the changes are associated with ICD-10 coding, which will be required when RREs are reporting dates of incidents occurring as of 10/01/15. ICD-10-related revisions […] Continue

MSA Surgery Mystery Solved

Commentary, Medicare Set-Aside Blog, MSP Litigation on September 26, 2014 | Posted by Jennifer Jordan, JD, MSCC

      After years of reviewing medical records and surgery pricing, I could never figure out what made surgical screws so expensive. Those screws look a lot like the ones we get bags full of at IKEA with any piece of furniture and I can furnish an entire room with what one pedicle screw […] Continue

Update: Upcoming Enhancement to the WCMSAP for Prescription Drug Information Rolling Out On October 6, 2014

CMS, Medicare Set-Aside Blog, MSP News, News and Events on September 23, 2014 | Posted by Louis

CMS issued an alert last month indicating that a new enhancement to the WCMSA portal for prescription drug treatment would be forthcoming.   Yesterday, CMS issued an additional alert confirming that this new feature will be available as of October 6, 2014.  A new training document, with images, showing the upcoming enhancement to the portal is […] Continue

NGHP Mandatory Insurer Reporting Alert: Final Five Digits of SSN is the New Minimum Requirement for Reporting, Effective 01/05/2015

CMS, Medicare Set-Aside Blog, MSP News, News and Events on September 16, 2014 | Posted by Jessica M. Wingenroth, JD

CMS has issued an Alert that effective 01/05/15, if an individual’s HICN or full SSN cannot be obtained, reporting can still occur as long as the individual’s last five digits of SSN, first and last name, date of birth and gender are produced. Nevertheless, reporting with a HICN or full SSN continues to be highly […] Continue

Paying Medicare Does Not Stop MSP Private Cause of Action Once Filed

CMS, Medicare Set-Aside Blog, MSP Litigation on September 3, 2014 | Posted by Jennifer Jordan, JD, MSCC

In the latest installment of what constitutes a private cause of action under the MSP, the US District Court for the Western District of Kentucky entered summary judgment on September 2, 2014 in favor of the estate of a Medicare beneficiary that filed suit over a conditional payment the defendant subsequently satisfied with Medicare in […] Continue

Notice of Upcoming Enhancement to the WCMSAP

CMS on August 21, 2014 | Posted by Jean S. Goldstein, JD

CMS posted an alert on the Workers’ Compensation Set-Aside Web Portal (WCMSAP) page indicating a new feature to be available as of October 6, 2014. As of this date, portal users will be able to enter prescription drug information directly into the portal for a specific submission. With this enhancement of the portal, new data […] Continue

S.2731 – Medicare Secondary Payer and Workers’ Compensation Settlement Agreements Act of 2013 Introduced to Senate

Commentary, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News on August 1, 2014 | Posted by Jennifer Jordan, JD, MSCC

On July 31, 2014, Senator Bill Nelson of Florida introduced the Senate version of H.R. 1982. Currently co-sponsored only by Senator Rob Portman, the bill was read twice, referred to the Committee on Finance and then the Senate promptly began its summer break. With introduction this late in the session, it will be interesting to […] Continue

3rd Circuit Affirms MSP Obligations are not Subject to NJ Collateral Source Statute

Commentary, Medicare Set-Aside Blog, MSP Litigation on July 31, 2014 | Posted by Jennifer Jordan, JD, MSCC

On July 29, 2014, the US Court of Appeals for the Third Circuit affirmed that Cecelia Taransky was required to reimburse Medicare regardless of the New Jersey’s collateral source statute. Ms. Taransky contended that she was prohibited by state statute from recovering medical expenses, however all evidence demonstrated that the Medicare conditional payment information was […] Continue

Medicare Trust Fund Exhaustion Pushed Back Until 2030

Medicare on July 28, 2014 | Posted by Jennifer Jordan, JD, MSCC

In its Trustees Report released July 28, 2014, CMS announced that the Medicare trust fund will remain solvent until 2030, four more years than previously projected, due in part to cost controls implemented in the Affordable Care Act. Factors that contributed to the improved outlook included lower than expected spending in 2013 and decreased overall […] Continue

Dueling MSA Recommendations

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

We knew it was inevitable but the day has come. The Court of Appeals of Ohio published an opinion within which the parties debate the need for an LMSA and use the polar extreme of MSA providers to argue their cases. Unlike dueling life care plans, this was not a case of high and low […] Continue