Category Archives: Blog

Blog, Medicare Conditional Payments, TPOC

As required by Section 202 of the SMART Act, CMS is required to annually review its costs relating to recovering conditional payments as compared to recovery amounts. Since 2017, CMS has maintained its threshold of $750.00 across all Non-Group Health Plan (NGHP) lines of business to include workers’ compensation, general liability, and no-fault insurance.  The threshold means that in scenarios …
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Blog, Legal/Legislative News, LMSA, Medicare Reporting Section 111, Medicare Set Aside

We have previously blogged regarding two Notice of Proposed Rulemakings (NPRMs) regarding Section 111 Civil Monetary Penalties and MSP and Future Medicals (which will propose options for LMSAs and/or protecting Medicare’s future interest in General Liability claims) pending on the Office of Management and Budget (OMB)’s website. Our prior blog on the Section 111 rulemaking can be found here and …
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Blog, Legal/Legislative News, Medicare Advantage Part C, Medicare Secondary Payer News, Pharma Part D

Insurance Companies and Self-Insureds that process claims for workers’ compensation, liability and no-fault claims (Primary Plans) involving Medicare beneficiary claimants need a better way to obtain information about Medicare Advantage and Part D Drug Plans that may have a claim for conditional payment reimbursement.  Numerous lawsuits have been filed across the Country demanding double damages for failure to reimburse Medicare …
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Blog, Medicare Secondary Payer News, Medicare Set Aside, WCMSA

CMS has released an updated WCMSA Reference Guide version 3.0. It can be found here.  The two significant changes are 1) CMS extending the Amended Review period from 4 to 6 years (Section 16.2), and 2) As of April 1, 2020, the required language for the signed consent form to submit an MSA to CMS now must include a statement …
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Blog, Legal/Legislative News, Medicare Jurisdiction, Trial Practice

Franco Signor has been following the CIGA (California Insurance Guaranty Association) litigation filed against HHS/CMS for some time. CIGA is California’s largest workers’ compensation provider as the insurer of last resort for employers where the employer/insurer is insolvent and unable to pay claims. Last we blogged about the case in 2017, the litigation was entitled CIGA v. Price, and the …
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Blog, Medicare Advantage Part C

Recall last year in 2018 we blogged that Humana Medicare Advantage had filed an action against Bi-Lo, LLC, a grocery retailer, in the U.S. District Court for the District of South Carolina for declaratory relief and monetary damages to recover amounts allegedly due and owing to Humana Medicare Advantage Organization (MAO) for payments made on behalf of Enrollee (the Medicare …
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Blog, Franco Signor News, Medicare Set Aside, WCMSA

PLOTTING A COMPLIANCE COURSE What to Consider When Determining Whether or Not to Submit an MSA to CMS By: Heather Sanderson and Claire Muselman For Workers Compensation Medicare Set-Asides (WCMSA), there is no requirement that they be submitted to the Centers for Medicare & Medicaid Services (CMS) for approval, although it is common for settling parties to do so. What …
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Franco Signor Medicare Blog Receives Prestigious Honor

05 Sep 2019 Jesse Hamby No Comments

About Franco Signor, Blog, Franco Signor News

Once again in 2019, Franco Signor’s Medicare Secondary Payer Compliance Blog has been chosen by Workerscompensation.com as one of the best blogs in the workers’ compensation industry. We want to thank all of you who took the time to nominate us. In addition, we want to thank the thousands of Franco Signor blog readers visiting our site each month. Franco Signor Chief Legal Officer …
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Blog, Legal/Legislative News, Medicare Set Aside, WCMSA

We have blogged on numerous occasions regarding Workers’ Compensation Medicare Set-Aside (WCMSA) legislation that continues to be re-introduced in Congress with slight variations over the last decade (hereinafter referred to as “WCMSA Bill”). Our 2018 blog on the prior WCMSA Bill can be found here. The current 2019 proposed WCMSA Bill can be found here. This year, the WCMSA Bill …
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Blog, Medicare Conditional Payments

On August 9, 2019, the Commercial Repayment Center (CRC) held an industry conference call and announced it was under mandate to reduce the current backlog of 338,819 conditional payment leads.  Instead of inundating the industry with hundreds of thousands of Conditional Payment Notices (CPNs), the CRC plans to ask Responsible Reporting Entities (RREs) to update their Section 111 data.  By …
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