Category Archives: Medicare Set Aside

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

We recently blogged that CMS delayed the Workers’ Compensation Review Contractor (the entity that reviews Workers’ Compensation Medicare Set-Asides) award to the 2ndquarter of 2017, with the solicitation being released in the 1st quarter. For our prior blog, click here. CMS has now released their draft Request for Proposal (RFP) as well as draft Statement of Work (SOW) for the Contractor.  While it is …
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Blog, Medicare Set Aside, WCMSA

According to the Court of Appeals of North Carolina, a WCMSA was not considered a “countable resource” for purposes of determining a claimant’s Medicaid eligibility, Williford v. North Carolina Department of Health and Human Services, 2016 N.C. App. LEXIS 1163 (November 15, 2016). The basic facts of the case involve a 68-year-old widow (Ms. Williford), who suffered a work injury …
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CMS Reduces MSP Liability Threshold for 2017 to $750

05 Dec 2016 Heather Sanderson No Comments

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

Yesterday, CMS announced that the threshold for liability settlements will reduce to $750. CMS will also maintain the $750 threshold for no-fault and workers’ compensation settlements, where the no-fault insurer or workers’ compensation entity does not otherwise have ongoing responsibility for medicals. To read CMS’ Alert click here. For CMS’ methodology in determining its 2017 thresholds, click here. Recall that …
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CMS Rescinds Recent Changes to Review of Zero Allocations

04 Nov 2016 Heather Sanderson No Comments

Blog, Legal/Legislative News, Medicare Set Aside

Last week, the Workers’ Compensation Review Contractor (WCRC) informally let the industry know that an internal quality review revealed that the WCRC was improperly applying CMS’ documentation requirements to the review of zero allocations in denied worker’s compensation claims. As such, additional documentation would now be required for the WCRC to issue an approval of a zero Medicare Set-Aside (MSA) …
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Blog, Medicare Set Aside

The MSA industry has been abuzz, and Franco Signor has confirmed with the Workers’ Compensation Review Contractor (WCRC), that changes are being made to the requirements for CMS to approve zero allocations based upon denial of the workers’ compensation claim. We have been informed that these corrections will be outlined in a policy memo soon, but that some of the …
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LMSA, Medicare Conditional Payments, Medicare Set Aside

A recent opinion out of the Eastern District of New York, Sexton v. Medicare, 2016 U.S. Dist. LEXIS 89815 (July 11, 2016), found that a Plaintiff cannot refute or defeat Medicare’s ability to recover conditional payments until the primary payer has demonstrated responsibility through a settlement, judgment or award. The brief facts involved Plaintiff Kevin Sexton (“Plaintiff”) being struck by …
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Blog, Medicare Set Aside, WCMSA

Alvarenga v. Scope Industries, et. al., WCAB #ADJ8733556 involves a settled workers’ compensation case for which a petition was filed to set-aside a Compromise & Release (C&R) because of mutual mistake.   The purported mistake was that the Medicare Set Aside (MSA), prepared by the Employer’s vendor, Helios, required review and approval by the Centers for Medicare & Medicaid Services (CMS).  …
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CMS Considering LMSA Review Process

10 Jun 2016 Heather Sanderson No Comments

Blog, LMSA

CMS issued an Alert yesterday which states: The Centers for Medicare and Medicaid Services (CMS) is considering expanding its voluntary Medicare Set-Aside Arrangements (MSA) amount review process to include the review of proposed liability insurance (including self-insurance) and no-fault insurance MSA amounts. CMS plans to work closely with the stakeholder community to identify how best to implement this potential expansion. …
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Call to Action: The Opioid Epidemic and WCMSAs

09 May 2016 Administrator No Comments

Administration, Blog, Legal/Legislative News, Medicare Jurisdiction, Medicare Set Aside

Franco Signor took an important step last week to inform the White House of a practice by CMS with regard to WCMSAs and the current opioid epidemic.  We have all heard the statistics and agree that action must be taken with regard to overuse and the over prescribing of opioids in the United States.  We applaud the administration’s recent efforts …
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Blog, Medicare Set Aside

Workers’ Compensation Medicare Set-Asides (WCMSAs) are a recommended tool by the Centers for Medicare and Medicaid Services (CMS) to evidence the protection of Medicare’s interests for workers’ compensation settlements. A fully accepted claim with undisputed treatment/injuries is rather simple from a submission and CMS review standpoint. However, where an Employer/Carrier has disputed or limited specific treatment or injuries based upon …
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