The Official Medicare Set Aside Blog And Information Resource

WCRC RFP Due Date Revised

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News on January 20, 2017 | Posted by Jean S. Goldstein, JD

Yesterday, CMS issued an amendment to the RFP for the WCMSA review contractor. The amendment published responses to questions by offerors, and informed offerors that additional answers to questions will be released on January 25, 2017. The amendment also reflects a change in the due date for proposals, to 10:00 am February 8, 2017. The […] Continue

MSP False Claims Action Reaching Its Conclusion

Medicare Set-Aside Blog, MSP Litigation, MSP News on January 18, 2017 | Posted by Jennifer Jordan, JD, MSCC

On January 18, 2017, the Second Circuit Court of Appeals brought an end to Kent Takemoto’s dreams of whistle blower riches. The Court upheld the District Court’s adoption of the Magistrate’s recommendation to dismiss the false claims action, finding that he failed to plead facts as to each defendant’s obligation to repay the government. Although […] Continue

150 Million Medicare Health Insurance Claim Numbers to be Changed to New Medicare Beneficiary Identifier Numbers in 2018

CMS, Medicare Set-Aside Blog, MSP News on January 18, 2017 | Posted by Katharine Rupp, JD

On Tuesday January 17, 2017, CMS held a special open door forum to discuss the changes and impact of the SSNRI on Medicare Secondary Payer (MSP) stakeholders. Starting April 1st, 2018, CMS will be replacing all Social Security Number (SSN) based Health Insurance Claim Numbers (HICN) with Medicare Beneficiary Identifier (MBI) numbers. Over 150 million […] Continue

CMS Releases Updated NGHP User Guide

CMS, Mandatory Insurer Reporting, Medicare Set-Aside Blog, MSP News on January 9, 2017 | Posted by Jean S. Goldstein, JD

CMS updated their Non-Group Health Plan (NGHP) User Guide, and released version 5.2.  The updated guide can be found here. The only update to the guide is the change in thresholds for reporting certain cases with total payment obligation to the claimant (TPOC), as indicated in CMS’ recently issued alerts and as previously discussed here […] Continue

CMS Special Open Door Forum to be Held

CMS, MSP News on January 4, 2017 | Posted by Jean S. Goldstein, JD

Yesterday, CMS announced that it will hold a conference call, a Special Open Door Forum, on Tuesday, January 17, 2017 at 3:00 pm EST.  The call will allow Medicare Secondary Payer stakeholders to learn and ask questions about changes involving the Social Security Number Removal Initiative, in general and in the context of MSP reporting. […] Continue

FINALLY—The Bid for the Workers’ Compensation Review Contractor (WCRC) Has Been Released.

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News on December 29, 2016 | Posted by Jean S. Goldstein, JD

CMS finally issued the solicitation for the Workers’ Compensation Review Contractor (WCRC) to review and evaluate workers’ compensation Medicare set-aside arrangements (WCMSA) submitted to CMS for review.  The WCRC’s role is to project future medical costs for those cases submitted as related to a workers’ compensation injury, illness, or disease that would otherwise be reimbursable […] Continue

How Will Mandatory Reporting Be Affected by CMS’ Announcements Regarding Thresholds?

CMS, Mandatory Insurer Reporting, Medicare Set-Aside Blog, MSP News on December 13, 2016 | Posted by Jean S. Goldstein, JD

CMS recently announced a change in the reporting thresholds to $750 for liability settlements, and advised that it would maintain the $750 threshold for no-fault and workers’ compensation settlements, where the insurer or entity does not otherwise have ongoing responsibility for medicals (ORM).  Just yesterday, CMS issued a technical alert regarding the change in reporting […] Continue

Draft RFP for WCRC Released…Again.

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News on November 30, 2016 | Posted by Jean S. Goldstein, JD

CMS recently released a draft RFP for a new Workers’ Compensation Review Contractor (WCRC) to review WCMSAs once again.  The draft RFP can be found here (Solicitation No: RFP-CMS-2016-8A-0008). Comments on the proposed RFP must be submitted by December 7, 2016, with the official solicitation for a new WCRC to be released in December.  The […] Continue

Teleconference Call Recap: CMS and CRC Address Delays and Enhancements  

CMS, Conditional Payments, CRC, Medicare Set-Aside Blog, MSP News on November 21, 2016 | Posted by Jean S. Goldstein, JD

On Thursday, November 17, the Centers of Medicare and Medicaid Services’ (CMS) held a teleconference, with both CMS representatives and Commercial Repayment Center (CRC) representatives available to provide long awaited explanations.  The call served as a general update for cases processed through the CRC, as a means to issue reminders to stakeholders, and to allow […] Continue

Is an MSA Technically a Trust?

Medicare Set-Aside Blog, Medicare Set-Asides, MSA Administration, MSP News on November 17, 2016 | Posted by Jennifer Jordan, JD, MSCC

In the early days of Medicare set-asides, we used to see the word “trust” thrown around quite freely. But from a legal perspective, the word trust carries very specific legal connotations that people didn’t want attached to MSAs, so little by little we saw the use of the word disappear. If professionally administered, you will […] Continue