The Official Medicare Set Aside Blog And Information Resource

Settling a Case in Arizona?  What You Need to Know About Full & Final Settlements

Medicare Set-Asides, MSP News, State Regulations on August 3, 2017 | Posted by Jean S. Goldstein, JD

Historically, workers’ compensation claims in Arizona have been subject to a number of limitations.  If additional medical treatment was needed, a claimant could reopen a claim at any time, despite the finality and resolution of the claim.  As a result, settlement of workers’ compensation claims in Arizona have been far less common because these claims […] Continue

New WCMSA Reference Guide Issued

CMS, Medicare, Medicare Set-Asides, MSP News, Re-Review Process on August 1, 2017 | Posted by Jean S. Goldstein, JD

As you may be aware, on July 10th, here on our blog we announced the quiet release of a change to CMS’ re-review process.  However, as we noted at that time, this process was not formalized by CMS, and had simply been released through CMS’ Workers’ Compensation Medicare Set-Aside Portal (WCMSAP).  Specifically, through a revised WCMSAP User Guide, […] Continue

Eyes on the Prize: A New CMS Re-Review Option is Available.

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News, WCRC on July 10, 2017 | Posted by Jean S. Goldstein, JD

While all eyes (and ears) have been focused on the news, or the lack thereof of news regarding the Workers’ Compensation Review Contractor award, CMS quietly released a change to their re-review process today.  The change was released through CMS’ Workers’ Compensation Medicare Set-Aside Portal (WCMSAP).  Specifically, through a revised WCMSAP User Guide, which can […] Continue

Will the WCRC Award Be Announced Tomorrow?

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, WCRC on June 29, 2017 | Posted by Jean S. Goldstein, JD

Tomorrow is June 30.  Per the Centers for Medicare & Medicaid Services (CMS), we are expecting that the Workers’ Compensation Review Contractor (WCRC) award will be announced tomorrow.  The WCRC is the entity responsible for projecting future medical costs that would otherwise be reimbursable by Medicare, for those cases submitted as related to a workers’ […] Continue

THE UR/IMR PROCESS: STILL GOOD ON ITS FACE.

CMS, Independent Medical Review, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News, Work Comp on June 21, 2017 | Posted by Jean S. Goldstein, JD

The California Supreme Court has determined that it will not review a case involving an injured worker who asserted that the Independent Medical Review (IMR) process was unconstitutional.  This is good news for California payers, furthering the defensive position that payers can continue to rely on both the Utilization Review (UR) and Independent Medical Review […] Continue

Countdown to October – Are You Ready for LMSAs and NFMSAs?   

CMS, Liability, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News on June 5, 2017 | Posted by Jennifer Alvarez, JD, RN, MSCC, CMSP

We are currently four months away from CMS implementing their new workflows for Medicare Administrative Contractors (MACs), which outline how they will handle bills when there is a Liability Insurance Medicare Set-Aside Arrangement (LMSA) or No-Fault Insurance Medicare Set-Aside Arrangement (NFMSA) involved in the settlement.  You may be aware that, in February 2017, CMS took […] Continue

MAO Recovery & Courts: Aggressively Pursuing Liens

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, MSP Litigation, MSP News on March 17, 2017 | Posted by Jean S. Goldstein, JD

On Wednesday, in the second decision of its kind this month, the United States District Court, Southern District of Florida denied in part and granted in part a Motion to Dismiss in a Medicare Advantage Organization (MAO) Medicare Secondary Payer Act (MSPA) recovery claim. MSPA Claims 1, LLC, et al. v. Century Surety Company, No. […] Continue

SPARC Act/Part D Prescription Drug Reform Reintroduced. What Does It Mean for MSP Recovery?

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News on February 24, 2017 | Posted by Jean S. Goldstein, JD

In September 2016, House Representative Bill 6120 known as the Secondary Payer Advancement, Reconciliation, and Clarification (SPARC) Act was first introduced to Congress.  The bill did not pass at that time, but was just recently reintroduced into the House of Representatives as HR 1122.  Text of the recent bill is not yet available. The bill […] Continue

WCRC RFP Due Date Revised, Again.

CMS, Medicare Set-Aside Blog, Medicare Set-Asides on February 10, 2017 | Posted by Jean S. Goldstein, JD

CMS just issued an additional amendment to the RFP for the WCMSA review contractor. The amendment published additional responses to questions by offerors, and also a change in the due date for proposals to 10:00 am February 15, 2017. The amendment to the solicitation can be found here. Stay tuned for more details. Continue