Category Archives: Medicare Jurisdiction

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 …

CMS Issues RFP for New MSA Contractor (WCRC)

26 Feb 2016 Heather Sanderson No Comments

Blog, Medicare Jurisdiction, WCMSA

  On February 22nd, CMS issued a Request for Proposal (RFP) which invites bids for the contractor that reviews WCMSA submissions- also known as the Workers’ Compensation Review Contractor (WCRC).  The proposal due date is April 8, 2016 and the anticipated award date is June 20, 2016. The RFP can be found here. A new contractor reviewing WCMSA submissions could …

Blog, Medicare Jurisdiction, Trial Practice

A recent Michigan state court ruling involving the Medicare Secondary Payer (MSP) Act has broad applications for the administration of worker’s compensation matters across the country.   If this decision stands, then liability for Medicare conditional payments is immediate once identified and it does not matter if the underlying filing is properly denied by the Employer. Typical reasons for denial by …

Takemoto False Claims Act Case Closed

21 Jan 2016 Heather Sanderson No Comments

Blog, Legal/Legislative News, Medicare Jurisdiction, Trial Practice

Earlier last year we blogged about this MSP False Claims Act case being recommended to be dismissed with prejudice by Magistrate Judge McCarthy. For our prior blog and further background on this case, please click here. Yesterday, United States District Judge William Skretny issued a decision and order denying Takemoto’s request to re-plead his case and objections to Judge McCarthy’s decisions. …

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 …

CMS Releases Stats on ICD-10 Transition

29 Oct 2015 Jesse Hamby No Comments

Blog, Medicare Jurisdiction, Medicare Reporting Section 111

CMS reports a smooth transition by Providers in using ICD-10 codes. As of 10/1/2015, Providers subject to HIPAA were mandated to use the new code set with over 64,000 codes compared to the roughly 14,000 codes that was available for ICD-9. The greater accuracy of the new code set will no doubt improve Medicare’s coordination of benefits, and RREs have …

Medicare Jurisdiction

Today, the Supreme Court of Florida issued an opinion regarding Medicare payments and the collateral source rule in John Joerg, Jr., etc. et. al v. State Farm Mutual Insurance Co. (October 15, 2015).   Background: In Florida, the collateral source rule provides that trial courts must reduce awards “by the total of all amounts which have been paid for the …

Blog, Franco Signor News, Medicare Jurisdiction, Medicare Secondary Payer News

We are told that we must protect Medicare’s interest. But what about our own? We are told in workers’ compensation settlements that involve a Medicare beneficiary, or a person who is “reasonably expected to become a Medicare beneficiary within 30 months of the settlement,” that we must protect Medicare’s interest. What does that mean and, more importantly, what is the …

Blog, Medicare Advantage Part C, Medicare Jurisdiction, Trial Practice

Infuse bone graft is FDA approved for certain spinal fusion procedures.  In 2002, Humana agreed to reimburse their insureds for off-label use in reliance on Medtronics’ medical literature that touted the benefits of the infuse product while underreporting its adverse effects.  Humana reversed this policy in February 2009 based on medical literature that questioned the safety and efficacy of Infuse …

ICD-10: One Week Out

25 Sep 2015 Jesse Hamby No Comments

Blog, Medicare Jurisdiction, Medicare Secondary Payer News

In one week, the U.S. health care system will start using the International Classification of Diseases, 10th Revision. This is a huge moment because ICD-10 will help doctors and other health care providers better: Define patients’ clinical status and treat their complex medical conditions. Coordinate care among providers. Support new payment methods that drive quality of care. Continue Reading

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