Category Archives: Medicare Set Aside

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 …

CMS issues WCMSA Reference Guide Version 2.4

02 Feb 2016 Heather Sanderson No Comments

Blog, Medicare Conditional Payments, WCMSA

We now have the third version of the WCMSA Reference Guide; however, the Reference Guide remains entirely the same with the exception of one addition.  The one change is the addition of the following to section 2.2: “Note: If Medicare is pursuing recovery directly from the WC insurer, the beneficiary, attorney or other representative will receive a copy of recovery …

Blog, Medicare Reporting Section 111, Medicare Secondary Payer News, Medicare Set Aside

The Casualty Actuarial Society (CAS) Committee on Health Care Issues recently analyzed ten cases to estimate the future impact of Medicare Secondary Payer reporting requirements to the P&C industry.  The CAS study was published in an article in Claims Journal.  The cases studied involved insurance in various lines of business: workers’ compensation, private passenger automobile and homeowners insurance.  The study …

More MSP Private Cause of Action “Action”

02 Sep 2015 Heather Sanderson No Comments

Blog, Medicare Advantage Part C, Medicare Jurisdiction, Medicare Secondary Payer News, Medicare Set Aside

A new opinion was just released out of the U.S. District Court for the Southern District of Florida, MSPA Claims 1, LLC v. IDS Property Casualty Insurance Company (August 28, 2015). This case involved MSPA Claims 1, LLC (“MSPA Claims”), as an assignee and on behalf of Florida Healthcare Plus (FHCP), a Medicare Advantage Plan (MAP), pursuing Property Casualty Insurance …

Blog, Legal/Legislative News, WCMSA

On June 4th, workers’ compensation Medicare Set-Aside (WCMSA) legislation was introduced in both the House and Senate. In identical bills, the House, the bill (HR 4269) was introduced by Representative Dave Reichert (R-WA) with lead co-sponsor Representative Mike Thompson (D-CA). In the Senate the bill (S 1514) was introduced by Senator Rob Portman (R-OH) with lead co-sponsor Senator Bill Nelson …

California WC Statute Helpful to Reduce WCMSA Allocations

15 May 2015 Heather Sanderson No Comments

Blog, Medicare Set Aside, WCMSA

SB 863 launched Independent Medical Review (IMR) for California Workers’ Compensation claims. This important shift in how medical treatment is managed in a workers’ compensation claim would inevitably lead to adjustments for workers’ compensation Medicare-Set Aside allocations (WCMSAs). In a recent decision, Caldera v. The Insurance Company of the State of Pennsylvania, 2013 U.S. App. LEXIS 9706, the 5th Circuit …

Blog, LMSA, Trial Practice

Legal Practitioners continue to seek guidance from Courts in absence of Centers for Medicare & Medicaid Services (CMS) rules on how to protect Medicare’s interest in a liability settlement.  We field calls every day from frustrated attorneys and claim handlers because of their concern about taking the right action to protect Medicare’s interests post-settlement.  CMS’ withdrawal of the NPRM on …

Blog, Trial Practice, WCMSA

The recent decision in the case of In re Arellano, 2015 Bankr. LEXIS 9 for the U.S. Bankruptcy Court for the Middle District of Pennsylvania made new law with regard to workers’ compensation settlements. One part dealt with whether a lump sum settlement amount could be exempt from the Bankruptcy estate. This issue did not involve the Medicare Secondary Payer …

Blog, Medicare Secondary Payer News, WCMSA

Recently, CMS has been busy making small changes that are now reflected in the Updated Guide dated January 5, 2015. We have blogged about these changes as they were originally released. However, they do warrant reiterating. Most notably are: 1. CR13265: Adding language to address schedule change for Hydrocodone compounds from schedule III to Schedule II. Click here to read …


On October 6, 2014, the Administration for the Drug Enforcement Administration (DEA) rescheduled hydrocodone combination products.  This was in response to the epidemic sweeping our Country because of the documented increase opioid abuse.  Consequently, these drugs were moved from Schedule III to Schedule II by the DEA as authorized under  the Comprehensive Drug Abuse Prevention and Control Act of 1970.   …

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