The Official Medicare Set Aside Blog And Information Resource

Collateral Source Rule in Delaware – Part II

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

In follow up to the Delaware Supreme Court ruling in Stayton v. Delaware Health Corp. [see blog dated June 22, 2015], declaring Medicare payments not subject to the collateral source rule, the Superior Court on July 28, 2015 extended the application to Medicare Advantage Plans as well. In Honey v. Bayhealth Medical Center, plaintiff attempted […] Continue

CMS’ Fraud Prevention System Creates Significant Impact

Fraud, Medicare, Medicare Set-Asides on July 29, 2015 | Posted by Jennifer Alvarez

The Centers for Medicare & Medicaid Services (CMS) recently recognized and applauded the agency’s internal Fraud Prevention System for the identification or prevention of $820 million in improper payments during the program’s first three years of operation. The focus of the Fraud Prevention System is to help protect Medicare Trust Funds and prevent fraudulent payments […] Continue

Social Security and Medicare Boards of Trustees Call for Swift Action by Lawmakers in 2015

CMS, Medicare, Medicare Set-Aside Blog, Social Security on July 27, 2015 | Posted by Jessica M. Wingenroth, JD

Last week the Social Security and Medicare Boards of Trustees released their 2015 Annual Reports, recommending “prompt corrective action by lawmakers.” In their Message to the Public, the most urgent action was called for the Social Security Disability Insurance program, which has trust fund reserves that are expected to deplete in late 2016. A 2016 […] Continue

Avinza Extended-Release Capsules No Longer Being Manufactured

Medicare, Medicare Set-Asides, Rx/Pharmacy on July 22, 2015 | Posted by Erin O'Neill, PA-C, JD

The Food and Drug Administration (FDA) has announced that all strengths of Avinza (morphine sulfate) extended release capsules have been discontinued. Avinza is a Schedule II long acting opioid medication indicated for the treatment of severe pain only. Avinza carried a black box warning indicating that misuse could lead to death due to the lack […] Continue

Town Hall Teleconference for NGHP Section 111 Mandatory Insurer Reporting Scheduled for July 28, 2015

CMS, Mandatory Insurer Reporting, News and Events on July 15, 2015 | Posted by Jessica M. Wingenroth, JD

A Town Hall Conference call for policy and technical questions has been scheduled for Tuesday, 07/28/15, from 1:00 PM to 2:00 PM EST. Full details can be found here: http://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Mandatory-Insurer-Reporting-For-Non-Group-Health-Plans/Downloads/New-Downloads/NGHP-Town-Hall-Teleconference-Notice-July-28-2015.pdf Continue

NGHP MMSEA Section 111 User Guide Version 4.7 Released

CMS, Mandatory Insurer Reporting, MSP News on July 14, 2015 | Posted by Jessica M. Wingenroth, JD

In their fourth update this year, CMS applied four change requests to Version 4.7 of the NGHP MMSEA Section 111 User Guide. All changes incorporated information published in prior Alerts. Within Version 4.7 you can find the new: Recovery Agent process with dedicated fields, eliminating the prior TPA workaround; Section 111 Coordination of Benefits Secure […] Continue

The Latest News Regarding Total Joint Replacement Procedures

CMS, Comprehensive Care For Joint Replacements, Outpatient Total Joint Replacement on July 13, 2015 | Posted by Erin O'Neill, PA-C, JD

Hip Knee Replacement Patients Leave Hospital Within Hours of Surgery  Cutting-Edge Outpatient Total Joint Replacement Program Helps Coastal Orthopedics Patients Heal Faster Articles, similar to the two noted in the links above, are beginning to appear in newspapers and journals across the country. Orthopedic surgeons are breaking new ground by performing total knee and total […] Continue

Changes to the Non-Group Health Plan Recovery Workload

CMS, Conditional Payments, ICD-10, Mandatory Insurer Reporting, Medicare Set-Aside Blog, News and Events on July 1, 2015 | Posted by Erin O'Neill, PA-C, JD

Following the 2013 transition of most Group Health Plan (GHP) recovery activity to the Commercial Repayment Center (CRC), CMS has announced that certain Non-Group Health Plan (NGHP) recovery activity will also be transitioned to the CRC in the near future. Effective October 2015, the CRC will assume the responsibility for conditional payment recovery activities in […] Continue

Is Medicare Advantage Entitled To Bring A Private Cause Of Action Under The Medicare Secondary Payer Act?

CMS, Medicare, Medicare Advantage, Medicare Set-Aside Blog, MSP Litigation on June 24, 2015 | Posted by Kimberly Wiswell

This law review article by Jennifer Jordan, general counsel at MEDVAL, was recently published in the William Mitchell Law Review. It’s an in-depth analysis of the current state of Medicare Advantage recovery rights and provides a well-reasoned rationale as to whether or not MAOs were intended to share exactly the same recovery rights as traditional […] Continue

Medicare Reimbursement and Collateral Source Rule in Delaware

Commentary, Medicare Set-Aside Blog, MSP Litigation on June 22, 2015 | Posted by Jennifer Jordan, JD, MSCC

On June 12, 2015, the Supreme Court of Delaware rendered a decision in Stayton v. Delaware Health Corporation, et al. opining that the collateral source rule would not apply in the recovery sought by the plaintiff. The case involves a 76 year old wheelchair bound resident of the Harbor Healthcare and Rehabilitation Center. Plaintiff is […] Continue