Category Archives: Medicare Set Aside

When to Use a Liability Medicare Set-Aside (LMSA)

30 May 2011 Roy Franco No Comments

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 to …
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Blog, LMSA, Medicare Set Aside

Claimant became a Medicare beneficiary as a result of injuries she sustained in an accident. Her attorney contacted Medicare to determine the amount of the conditional payment, but found nothing was owed. Concerned that Medicare may make payments in the future that are related to the incident in question, the attorney made sure to create a system to prevent this …
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Medicare Set Aside Protocol in the WDNY

06 May 2011 Jeff Signor No Comments

Blog, Medicare Reporting Section 111, Medicare Set Aside, WCMSA

Today I had the honor of presenting on the topic of Medicare Secondary Payor Compliance with Robert Trusiak, Esq, Assistant US Attorney for the Western District of New York.  We presented at the headquarters of the Erie County Bar Association, and the presentation was sponsored by the Western New York Chapter of the Women’s Bar Association.  The protocol is set …
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Blog, LMSA, Medicare Set Aside

It was bound to happen.  When legal responsibility exists to comply with a law, but no policy or procedure is in effect as to how, parties to a liability case will fashion their own solution.  That’s exactly what took place in Big R Towing, Inc. v. David Wayne Benoit, et al,  2011 U.S. Dist. LEXIS 1392 where the court was …
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Blog, Medicare Set Aside, WCMSA

By Alvena Ferreira, RN, CCM, CNLCP, MSCC and Katie A. Fox, MSCC Effective December 1, 2010, the New York State Worker’s Compensation Board will implement medical treatment guidelines for injuries to the neck, mid and low back, shoulder, and knee. The guideline documents state that these were developed in part from the State of Colorado’s guidelines and ACOEM guidelines. The …
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Blog, Medicare Set Aside, WCMSA

By Alvena Ferreira, RN, CCM, CNLCP, MSCC and Katie A. Fox, MSCC On November 5, 2010 the FDA approved Cymbalta (duloxetine hydrochloride), an antidepressant, to treat chronic back pain as well as osteoarthritis. The dosage that can be prescribed is 60 mg/day.  Previously, Cymbalta was only authorized for the treatment of diabetic peripheral neuropathy, generalized anxiety disorder, and fibromyalgia.  The expansion …
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