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
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
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
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 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
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
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
CMS posted a notification on their website that they will begin to utilize the CDC’s Table 1: Life Table for the total population: United States, 2012 on April 1, 2017. This means that for any WCMSA proposal received by CMS, or where any WCMSA case is reopened on or after April 1, 2017 CMS will apply […] Continue
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
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