Category Archives: Medicare Set Aside

New Jersey No Longer Mandates WCMSA in WC Settlements

27 Jul 2012 Roy Franco No Comments

Medicare Set Aside, WCMSA

Katie A. Fox, MSCC VP Medicare Compliance – WC Alvena Ferreira, Senior Nurse Allocator Medicare Compliance is at the forefront of all parties in the resolution of a workers’ compensation claim. In 2005, Peter J. Calderone, Director/Chief Judge of Workers’ Compensation, issued the first Memorandum on Medicare Compliance. Chief Calderone has recommended periodic judicial review of the status of the …
READ MORE

LMSA, Medicare Set Aside

In a recent blog we highlighted a reference by CMS to an “Advanced Notice of Proposed Rulemaking” on the issue of “Liability Medicare Set Asides.” The final document has been sent to the Federal Register, where it will be published in a few days, and here is an advanced copy: CMS-6047-ANPRM. In the document, the Agency proposes seven different options …
READ MORE

Allocation, LMSA, Medicare Conditional Payments, Medicare Set Aside

Bertrand v. Talen’s Marine & Fuel LLC, 2012 US Dist. LEXIS 78053 (U.S. Dist. Court for the Western District of Louisiana, 6/4/2012). Facts: (A condensed version of the Court’s Findings of Fact are set forth below): Plaintiff was injured in a workplace accident, and he was employed, at the time, by defendant Talen’s. As a result of the accident, plaintiff …
READ MORE

LMSA, Medicare Set Aside

Frank vs. Gateway Insurance Company, 2012 U.S. Dist. LEXIS 33581 (U.S. Dist. Court for the Western Dist. of Louisiana, March 3, 2012) Facts:  Plaintiff was injured while in the course and scope of his employment.  He was a truck driver and at the time of the accident was unloading a trailer owned by a third party.  He suffered a lumbar …
READ MORE

Legitimizing an MSA – A Need for More Guidance

13 Apr 2012 Roy Franco No Comments

Blog, LMSA, Medicare Set Aside

How does one determine exactly the amount that should be allocated for future medicals so that the risk of triggering Medicare recovery is minimized? And what kind of proof do you need?  Because CMS has stated that nothing will limit its recovery other than a court order on the merits of the case (CMS Pub. 100-05, Chapter 7, §50.4.4), claimants …
READ MORE

Blog, Medicare Set Aside, WCMSA

We previously thought Workers’ Compensation Medicare Set-aside Arrangements (WCMSA) funds were sacrosanct and not available for any other purpose, except to pay for medical care related to the settled workers’ compensation injury.  This does not appear to be the case in Illinois.  A recent Appellate Court decision from the Third District of Illinois has muddied the waters for what was …
READ MORE

Blog, Medicare Set Aside, WCMSA

The worker’s compensation system has been notorious for settlement of a “denied claim.” These are the claims where the cost to litigate the matter is greater than the settlement options. Thus, in exchange for a sum of money the Claimant agrees to discontinue their application for WC benefits. Over the years we have witnessed the Centers for Medicare and Medicaid …
READ MORE

Medicare Reporting Section 111, ORM, WCMSA

Katie A. Fox, MSCC – October 21, 2011 The much awaited Version 3.2 of the User Guide was released on August, 17, 2011. The User Guide outlines several changes, but hidden in section 11.8 is a process to manually terminate the ORM status between Section 111 claim detail electronic submissions.  Throughout the industry the subsequent memorandums have gained much publicity, …
READ MORE

CMS Updates MSP Compliance for Liability Claims

03 Oct 2011 Jeff Signor No Comments

Blog, LMSA, Medicare Secondary Payer News, Medicare Set Aside

This memo is consistent with our article about the LMSA and confirms the roadmap we have in place for our clients. We are now working on a form letter to put before the treating doctor to execute. If this letter cannot be secured, we recommend following our roadmap to make certain Medicare’s interests are properly protected. Cooperation of the plaintiff and his/her representative will be key. However, the memo should improve cooperation in this regard.
READ MORE

Blog, LMSA, Medicare Set Aside

  The Centers for Medicare & Medicaid Services (CMS) has put the insurance industry on high alert. Threat of penalties for failure to report liability claims involving a Medicare beneficiary has raised concerns over properly meeting obligations owed Medicare.  One particular question has raised  great controversy – Does a settlement, judgment, award, or other payment to a Medicare beneficiary need …
READ MORE

© 2012-2017 Franco Signor LLC