Category Archives: Medicare Set Aside

Blog, LMSA, Medicare Secondary Payer News

Click here to read the recent Computation of Annual Liability Insurance (Including Self-Insurance) Settlement Recovery Threshold report that was submitted to the Congress pursuant to Section 202 of the SMART Act.

Blog, LMSA, Medicare Set Aside

Last week the Centers for Medicare & Medicaid Services (CMS) withdrew its proposed regulation for future medicals with respect to liability claim settlements. The Notice of Proposed Rulemaking (NPRRM) was submitted to the Office of Management & Budget over a year ago on August 1, 2013. The CMS submission can be found here. The NPRM was expected to cover how …
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Is Congress Finally Moving Forward with WCMSA Reform?

07 Aug 2014 Roy Franco No Comments

Blog, WCMSA

A couple of weeks ago I published an article with Insurance Thought Leadership to marshal support for a strategy for WCMSA legislation should H.R. 1982 not past this year.  Since then, the Senate has introduced companion legislation in the form of S. 2731.    The pathway to a law is still unclear, nonetheless,  introduction of S. 2731 is a major step …
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It’s Time to Rethink WCMSA Legislation

29 Jul 2014 Jesse Hamby No Comments

Blog, WCMSA

This article is featured on insurancethoughtleadership.com. A fresh approach may be needed to address how best to protect Medicare’s interest in a workers’ compensation settlement. Today, the Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) is a routine part of most settlements. The WCMSA takes a part of the workers’ compensation settlement and allocates it specifically for future medical expense. If this …
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Blog, LMSA

What a waste of time.  In Tye v. Upper Valley Medical Center, the parties held up a settlement for almost two years because of the defendant’s insistence of a Medicare Set Aside.  This case involved a medical malpractice settlement that occurred on July 21, 2012.  It was a personal injury settlement, that was “conditionally dismissed without prejudice until such time …
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Blog, LMSA

Many times we are asked when CMS will issue regulations related to protecting Medicare’s interest in a liability case.  The short answer is: No person outside of CMS really knows.  Thus far, CMS has taken the following steps toward possible rule-making.  1) Issued a Policy Memo on Future Medicals and Liability Claims, on September 30, 2011, that does not explain …
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CMS Issues WCMSA User Guide 2.2 Today

03 Jun 2014 sshamrock No Comments

Blog, Medicare Secondary Payer News, WCMSA

Written by: Steve Shamrock, VP of Operations, Clinical Today, the Centers for Medicare & Medicaid Services (CMS), in an effort to improve the WCMSA process, updated its user guide.  A catalyst for the release, was concern over the increase in development letters and requests for additional medical records.  While Franco Signor did not experience this problem to the degree and severity expressed by …
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Blog, Medicare Jurisdiction, Medicare Set Aside

This is an appeal taken by the injured worker with regard to her pending workers’ compensation claim.  Several issues were raised, but germane to the issue of the Medicare Set-Aside was whether the Employer Insurance carrier could compel medical discovery to assist in the development of a potential Medicare Set Aside.  The State of North Carolina agreed that it could, …
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CMS Publishes New WCMSA Self-Administration Page

11 Apr 2014 Jesse Hamby No Comments

Blog, WCMSA

CMS is aggressive on improving its website to offer information needed by the Industry.  The latest reveal is a section of its website to house information about WCMSA.  It includes documents necessary for self-administration of the MSA and latest WCMSA user guides.  It’s definitely one to add to your web favorites list to check regularly for updates.

Court Slams Petitioner for Poor Draft of Release

03 Apr 2014 Roy Franco No Comments

Blog, WCMSA

At the conclusion of a claim involving a Medicare beneficiary, it is important that the Release terms be clear on its face.  The Medicare Secondary Payer Act requires Parties to work collaboratively to secure finality with regard to its compliance.  When that collaboration breaks down, the terms of the Release will more than likely control the outcome.  If clear on …
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