The Official Medicare Set Aside Blog And Information Resource

11th Circuit Finds MAOs May Bring Double Damages Private Cause of Action Against Medical Providers

CMS, Medicare Advantage, Medicare Set-Aside Blog, MSP Litigation on March 21, 2018 | Posted by Jean S. Goldstein, JD

The 11th Circuit issued an opinion yesterday on a Motion to Dismiss on a claim addressing a new question, one they have never been faced with before: Whether an MAO has a private cause of action against the recipient, or a provider of a primary payment. Claims v. Bayfront Hma Med. Ctr., 2018 U.S. Dist. […] Continue

Updated WCMSA Reference Guide Issued

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, WCRC on March 21, 2018 | Posted by Jean S. Goldstein, JD

An updated Workers’ Compensation Medicare Set-Aside (WCMSA) reference guide has been issued.  The revised guide, version 2.7, can be found here. The revised WCMSA reference guide has two minor updates, which are: An updated phone number for the new Workers’ Compensation Review Contractor “WCRC” (1-833-295-3773 between 9am-5pm EST, Monday thru Friday); and A revised Confidentiality […] Continue

New CRC Contractor: What Are Our First Impressions?

Conditional Payments, CRC, Medicare Set-Aside Blog, MSP News, WCRC on March 20, 2018 | Posted by Jean S. Goldstein, JD

It’s been over a month since the anticipated transition of the Commercial Repayment Center (CRC) contractor from CGI Federal to Performant Recovery.  Our first impressions have all been positive.  As with all transitions to new government contractors, we of course had some reservations and concerns, but to date are encountering only positive experiences. Some quick […] Continue

Second Circuit Court Addresses Whether An MAO May Bring Suit: Primary Payer Takes the Hit

Medicare Advantage, Medicare Set-Aside Blog, MSP Litigation, MSP News on March 15, 2018 | Posted by Jean S. Goldstein, JD

Nearly every week those of us in the Medicare Secondary Payer (MSP) industry receive alerts about a new Medicare Advantage Organization (MAO) bringing suit for failure to provide reimbursement for conditional payments made by an MAO on behalf of a Medicare beneficiary.  Many of these suits come out of the Third and Eleventh Circuits, and […] Continue

WCRC Transition to be Seamless and Promising

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News, WCRC on March 7, 2018 | Posted by Jean S. Goldstein, JD

CMS and Capitol Bridge LLC, the entity taking over as the new Workers’ Compensation Review Contractor (WCRC) held a webinar today regarding the planned WCRC transition.  CMS introduced Capitol Bridge, who categorically addressed concerns regarding the transition.  It was quite clearly stated that today’s webinar would not address any policy questions, but simply address transition […] Continue

Capitol Bridge WCRC Transition Planned for 03/19/18

CMS, CRC, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News, WCRC on March 1, 2018 | Posted by Jessica M. Wingenroth, JD

CMS has invited the industry to participate in a Transition Webinar on 03/07/18 at 1:00 PM ET to discuss the transition of the Workers’ Compensation Review Contractor (WCRC) from Provider Resources, Inc. to Capitol Bridge, LLC. Capitol Bridge will assume responsibility of the WCRC contract on 03/19/18. As you may recall from our prior reports, […] Continue

MSP Stakeholders Exempt from CMS Beneficiary Identifier Changes: Everything You Need to Know About New MBIs

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, Social Security on February 26, 2018 | Posted by Katharine Rupp, JD

Earlier this month, CMS held an open-door forum regarding the impending initiative to remove Social Security numbers (SSN) from all Medicare cards. As we previously reported, this plan aims to generate a new Medicare Beneficiary Identifier (MBI) for over 150 million Medicare beneficiaries; both active and deceased beneficiaries. The MBI will replace all SSN based […] Continue

The Possibility of Settling Denied Arizona WC Claims is Off the Table; Senate Bill 1100 Transmitted to the House in Amended Form

Medicare Set-Asides, MSP News, State Regulations on February 22, 2018 | Posted by Jennifer J. Mislanovich, JD

As we noted last year, in our post “Settling a Case in Arizona? What You Need to Know About Full & Final Settlements,” Arizona enacted Senate Bill 1332 (SB 1332), allowing permanent closure of all medical benefits in accepted claim. Last month we thought it might be possible that denied claims would follow suit when […] Continue

FDA Greenlights Marketing of First Blood Test Designed to Aid in Diagnosis and Evaluation of Concussions

CMS, Medicare, Medicare Set-Aside Blog, MSP News on February 15, 2018 | Posted by Erin O'Neill, PA-C, JD

On February 14, 2018, the Food and Drug Administration (FDA) announced authorization of marketing of the Banyan Brain Trauma Indicator, which is the first blood test of its kind designed to aid in the evaluation of mild traumatic brain injuries (concussions) in adults. The blood test is designed to detect the presence of two protein […] Continue

Sublocade – A New Once-Monthly Injection for the Treatment of Opioid Use Disorder

CMS, FDA, Medicare, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News, Opioids on February 5, 2018 | Posted by Katherine Bales, RN, JD

The opioid crisis continues to be one of the most talked about issues facing the health care community, and the nation as a whole, having been declared a national public health emergency. In response, pharmaceutical companies have been actively working on ways to treat the crisis with the development of alternative treatment methods. The FDA […] Continue