Category Archives: Medicare Set Aside

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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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, WCMSA

Earlier this year, we blogged about CMS updating its WCMSA Reference Guide. Specifically, we pointed out that CMS for the first time included explicit examples in which the settlements would not meet CMS’ Review Threshold for review of a proposed WCMSA, but which would still require consideration of Medicare’s interests. The first example involved an under-threshold Medicare beneficiary settlement, and …
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About Franco Signor, Administration, Blog, Legal/Legislative News

BRADENTON, Fla., April 1, 2019 /PRNewswire/ — Franco Signor announced today its new Post-Settlement Administration Services. The service platform is available to injured parties at www.CareMDRx.com. This new platform is designed for individuals that have settled their workers’ compensation or personal injury case and have future medical care needs. Post-Settlement Administration Services are commonly used by individuals who may be …
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CMS Updates WCMSA Reference Guide and NGHP User Guide

09 Jan 2019 Heather Sanderson No Comments

Blog, Medicare Set Aside, WCMSA

Yet another indication that The Centers for Medicare & Medicaid Services (CMS) intends to make Medicare Secondary Payer (MSP) enforcement a priority in 2019: both the WCMSA Reference Guide and NGHP User Guide have been updated with several impactful changes. The updated WCMSA Reference Guide can be found here, and the updated NGHP User Guide can be found here. WCMSA …
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Blog, LMSA

A proposed rulemaking on “Miscellaneous Medicare Secondary Payer Clarifications and Updates” has been posted on the Office of Management and Budget website. The proposed rulemaking can be found here. The abstract of the rule states:  “This proposed rule would ensure that beneficiaries are making the best health care choices possible by providing them and their representatives with the opportunity to select …
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Blog, Medicare Secondary Payer News, Medicare Set Aside, Pharma Part D, WCMSA

What is the intended purpose behind a Workers’ Compensation Medicare Set-Aside (WCMSA)? The WCMSA Reference Guide, Section 3.0 states: “A WCMSA allocates a portion of the WC settlement for all future work-injury-related medical expenses that are covered and otherwise reimbursable by Medicare (“Medicare covered”) (emphasis added). Accordingly, Medicare through its issued guidance has provided that medical expenses should not be …
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Blog, Medicare Jurisdiction, Medicare Set Aside

As of October 1, 2018, both the Non-Group Health Plan (NGHP) User Guide and Workers’ Compensation Medicare Set-Aside (WCMSA) Reference Guide have been updated with minor changes. The updated NGHP User Guide can be found here and the updated WCMSA Reference Guide can be found here. Below are summaries of the changes in both of the Guides: NGHP User Guide: …
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Administration, Blog, Legal/Legislative News, Medicare Set Aside, WCMSA

For numerous years, a slightly varied version of essentially the same proposed legislation regarding Workers’ Compensation Medicare Set-Asides (WCMSAs) continues to be re-introduced in Congress (hereinafter referred to as “MSA Bill”). Just last week, the MSA Bill was again introduced in the Senate. It is titled “Medicare Secondary Payer and Workers’ Compensation Settlement Agreements Act of 2018.” A copy of …
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Settlement Contingent Upon CMS Approval of WCMSA: Problematic?

08 May 2018 Heather Sanderson No Comments

Blog, Legal/Legislative News, Medicare Secondary Payer News, WCMSA

A decision just issued out of the Third Circuit Court of Appeal in Louisiana demonstrates the various nuances and obstacles that may be present when entering into a workers’ compensation settlement contingent upon CMS approval of a WCMSA. In Ortega v. Cantu Servs., Inc. 2018 La. App. LEXIS 845 (May 2, 2018), the claimant, a Medicare beneficiary, settled her disputed …
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