The Official Medicare Set Aside Blog And Information Resource


CMS, Medicare Set-Aside Blog, WCRC on October 14, 2020
Posted by Noel D. Sturtz, Client Program Manager

An Amended Review success for our client: Their initial CMS-approved MSA included lumbar surgery and a spinal cord stimulator, both of which we had allocated based on the records reviewed. Per the additional records for the Amended Review, the claimant subsequently underwent lumbar fusion, with significant improvement such that the treating physician ultimately concluded that […] Continue

Updated WCMSA Reference Guide Issued with Newly Added Appendix 7: Major Medical Centers by State, National Provider Identifier and Zip Code

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, WCRC on October 6, 2020
Posted by Noel D. Sturtz, Client Program Manager

On October 5, 2020, the Centers for Medicare & Medicaid Services (CMS) released a revised Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide. The updated Guide is version 3.2. As with other versions, a summary of updates to the Guide is found in Section 1.1, and consists of the following changes: The major medical centers […] Continue

Best Practices for Conditional Payment Appeals and More Questions Answered by the CRC and CMS MSP Operations Team

CMS, Conditional Payments, CRC, Medicare Set-Aside Blog on October 2, 2020
Posted by Jessica M. Wingenroth, JD

Last week representatives from the Commercial Repayment Center (CRC) and Centers for Medicare and Medicaid Services (CMS) Medicare Secondary Payer (MSP) Operations teams hosted a webinar on best practices for conditional payment redetermination requests for Non-Group Health Plan (NGHP) payers. The presentation included a review of the five levels of the Medicare appeals process, the […] Continue

CMS Webinar August 13, 2020 Section 111 Mandatory Insurance Reporting for Non-Group Health Plans (NGHP). Questions and Answers Now Available

CMS, Mandatory Insurer Reporting, Medicare Set-Aside Blog on September 18, 2020
Posted by Noel D. Sturtz, Client Program Manager

Following up on our July 15, 2020 Blog, The Centers for Medicare & Medicaid Services (CMS) has released to the public the August 13, 2020 Section 111 NGHP Reporting webinar and Questions and Answers document. The presentation highlighted Section 111 reporting tips, best practices, and reminders, as well as Medicare Secondary Payer Recovery Portal (MSPRP) […] Continue

CMS to Host Webinar on NGHP Appeals

CMS, Conditional Payments, Medicare Set-Aside Blog on August 25, 2020
Posted by Jean S. Goldstein, JD, CMSP

The Centers for Medicare & Medicaid Services (CMS) recently announced that it will be hosting a Commerical Repayment Center (CRC) Non-Group Health plan appeals webinar on September 24, 2020 to review the procedures and best practices for redeterminations (first-level appeals). The complete webinar information is available in the Downloads section of the Coordination of Benefits […] Continue