The Official Medicare Set Aside Blog And Information Resource

H.R.5881 Introduced in An Effort to Add Transparency to MSP Reporting Information

CMS, Medicaid, Medicare, Medicare Advantage, Medicare Set-Aside Blog, MSP News on May 22, 2018
Posted by Jean S. Goldstein, JD

Last week, Congressman Gus Bilirakis and Congressman Ron Kind introduced legislation (H.R. 5881) in the House of Representatives to amend title XVIII of the Social Security Act, specifically in an effort to provide for transparency of Medicare Secondary Payer (MSP) reporting information.  Congressman Bilirakis issued a press release yesterday stating that, “[t]his legislation will ensure […] Continue

CMS Issues Revised WCMSA Self-Administration Toolkit, Version 1.2

CMS, Medicare Set-Aside Blog, MSP News on May 7, 2018
Posted by Jean S. Goldstein, JD

The Centers for Medicare & Medicaid Services (CMS) recently issued a revised self-administration toolkit, version 1.2. The purpose of the toolkit, just as with the previous version is outlined on page 3 of the 31 page guide, which is to describe the Workers’ Compensation Medicare Set-Aside (WCMSA) self-administration process and provide guidelines for claimants.  Specifically, […] Continue

CMS Posts Update of Medicare Part D Opioid Prescribing Mapping Tool

CMS, Medicare Set-Aside Blog, Opioids on April 17, 2018
Posted by Jean S. Goldstein, JD

The Centers for Medicare & Medicaid Services (CMS) released an updated version of the Medicare Part D opioid prescribing mapping tool, providing an interactive, web-based resource that presents geographic comparisons- at the state, county, and ZIP code levels – of Medicare Part D opioid prescribing rates.  The tool allows users to understand and compare opioid […] Continue

CMS Issues Updates for Medicare Advantage and Prescription Drug Benefit Program: Will it Affect Your WCMSA?

CMS, Medicare Advantage, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News, Opioids on April 5, 2018
Posted by Jean S. Goldstein, JD

Earlier this week, CMS issued a policy change revising the Medicare Advantage Program (MAP) Part C regulations and Prescription Drug Benefit program (Part D).  The ultimate goal of the new policy is to ensure that individual’s treatment needs are met, while improving the quality of care and providing greater choices to MA enrollees.  The full […] Continue

CMS Increased Conditional Payment Demand by $142k: New York Supreme Court Vacates Settlement Agreement

CMS, Conditional Payments, Medicare Set-Aside Blog, MSP Litigation on March 26, 2018
Posted by Jean S. Goldstein, JD

An interesting case came out of the Supreme Court of New York City on Friday, challenging whether a settlement agreement may be declared null and void based upon an erroneous assumption of the total sum of conditional payments made by Medicare.  Mayo v. NYU Langone Med. Ctr., 2018 NY Slip Op 30456(U) (Sup. Ct.). The parties litigated […] Continue

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

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