Category Archives: Medicare Conditional Payments

Blog, Medicare Conditional Payments

In an opinion out of California District Court for the Central District of California, CIGA v. Burwell, 2016 U.S. Dist. LEXIS 34163 (March 16, 2016), California Insurance Guaranty Association (“CIGA”) filed a declaratory and injunctive relief action against Defendants Sylvia Mathews Burwell, United States Department of Health and Human Services, and the Centers for Medicare and Medicaid Services (collectively, “United …
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Commercial Repayment Center Issuing Demands on WC/NF Claims

14 Mar 2016 Heather Sanderson No Comments

Blog, Medicare Conditional Payments, Medicare Jurisdiction, Medicare Reporting Section 111, Medicare Secondary Payer News

The Commercial Repayment Center (CRC) took over a portion of the non-group health plan conditional payment recoveries on October 1, 2015. The CRC is charged with recoveries where the identified debtor is the insurance carrier and CMS has been notified via Section 111 reporting of a primary payer. The Benefits Coordination and Recovery Contractor (BCRC) continues to pursue recoveries where …
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Blog, Medicare Conditional Payments, MSPRC Appeals, Trial Practice

Anderson v. Burwell, 2016 U.S. Dist. LEXIS 26633 (March 3, 2016), arises out of the United States District Court for the Eastern District of Michigan, Southern Division.  It raises many interesting Medicare Secondary Payer (MSP) conditional payment reimbursement issues. The background of the case essentially involves a Plaintiff, Roland Anderson, Jr. (“Plaintiff”) who was the personal representative of the estate …
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CMS issues WCMSA Reference Guide Version 2.4

02 Feb 2016 Heather Sanderson No Comments

Blog, Medicare Conditional Payments, WCMSA

We now have the third version of the WCMSA Reference Guide; however, the Reference Guide remains entirely the same with the exception of one addition.  The one change is the addition of the following to section 2.2: “Note: If Medicare is pursuing recovery directly from the WC insurer, the beneficiary, attorney or other representative will receive a copy of recovery …
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Blog, Franco Signor News, Medicare Conditional Payments

Check out Heather Sanderson’s new article in this month’s Claims Management magazine.  Staying Ahead of the New CMS Conditional Payment Recovery Policies

Blog, Franco Signor News, Medicare Conditional Payments

Check out Heather Sanderson’s new article in this month’s Claims Management magazine.  Staying Ahead of the New CMS Conditional Payment Recovery Policies

Blog, Medicare Conditional Payments

Recently we blogged that CMS had planned to go-live with its pre-settlement final demand functionality on January 1, 2016, but instead CMS has moved it up to December 21st.  In its announcement, CMS provided some additional information on how the process required by the SMART Act will now work. To view the CMS alert in its entirety, please click here.  Commentary: CMS has elected to limit …
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Blog, Medicare Conditional Payments, Reimbursements

We recently blogged on CMS’ announcement regarding maintaining the $1000 settlement threshold for liability insurance (including self-insurance) wherein CMS would not require reimbursement of conditional payments and would not require Section 111 reporting. CMS is required to annually produce a liability threshold amount pursuant to the SMART Act. Our prior blog can be accessed here. Since then, CMS has released …
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Blog, Legal/Legislative News, Medicare Conditional Payments, MSPRC, Reimbursements

In a decision out of the Supreme Court of Iowa, an attorney, Paul Silich’s (Silich) law license has been suspended for thirty days for failure to timely handle and reimburse Medicare conditional payments and for violating several ethical attorney professional rules. The background of the case involved Silich’s legal representation of a Medicare beneficiary, Nancy Sanderson (Sanderson), who fell out …
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Blog, Medicare Conditional Payments, Medicare Jurisdiction

Yesterday, CMS issued an alert which states: As part of the Strengthening Medicare and Repaying Taxpayers Act of 2012 (the SMART Act), the MSPRP will be modified to include Final CP process functionality by January 1, 2016.  This new functionality will permit authorized MSPRP users to notify CMS that a recovery case is 120 days (or less) from an anticipated …
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