Category Archives: Medicare Set Aside

Blog, Trial Practice, WCMSA

In Benoit v. MMR Group et. al., 2014 La. App. LEXIS 716, the state court of appeals was asked to rule on an applicant’s attorney request for fees related to seed money secured from an insurer for a WCMSA.  The court examined the approval documents for the WCMSA from CMS review contractor and noted the prohibitory language regarding the award …
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Administration, Blog, WCMSA

On 2/11/2014, CMS requested from the Industry regarding its proposed expansion of the re-review process for a WCMSA.  CMS has always allowed its contractor to conduct re-reviews for mathematical errors or where certain records were omitted with the original submission, but after years of Industry concerns is considering this important expansion of the process. CMS has agreed to take comments …
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Allocation, Blog, Medicare Set Aside, Trial Practice

On November 21, 2013, the Oklahoma Civil Court of Appeals decided a case about whether an Employer was forced to disburse a proposed Medicare Set Aside amount, when it was later determined Claimant was ineligible for Medicare benefits.  The ruling was for the Employer and against the Claimant.  In this case, the settlement included a clear record regarding the Medicare …
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Administration, Blog, Medicare Secondary Payer News, Medicare Set Aside, WCMSA

On 2/11/2014, CMS issued an important request for comment to expand WCMSA Re-Review Process.  Today, the WCMSA Re-Review process is limited to situations where: 1) CMS has notified the submitter of missing documentation; or 2) A mathematical error was made by Medicare’s review contractor of the WCMSA.  These limited situations have proved less than adequate for most situations where obvious errors could …
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New WCMSA Reference Guide is Now Available

06 Nov 2013 Roy Franco No Comments

Blog, Medicare Set Aside, WCMSA

Today, CMS released its latest Reference Guide for WCMSA reflecting additional enhancements to the WCMSA process.  Stakeholders will be notified of these proposed changes prior to implementation. Please continue to monitor the WCMSA website for updates. The following sections of the Guide have been enhanced or added: 9.4.1.1 – Most Frequent Reasons for Development Requests: The five most common omissions as …
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Blog, WCMSA

Several amendments to O.G.G.A. Section 34-9-200 (Georgia Workers’ Compensation Act) recently took effect after passing the Georgia legislature by unanimous vote.    One amendment, noteworthy for Workers’ Compensation Medicare Set Asides (WCMSA) is a new 400 week limit imposed on medical benefits for claims occurring on or after July 1, 2013 for non-catastrophic injury claims.   This change in the law harmonizes …
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Administration, Blog, Medicare Conditional Payments, Medicare Jurisdiction

The stalemate in D.C. has now reached the front-line adjuster’s desk.  Non-essential employees for most Federal Agencies have been furloughed and this includes key personnel within the Centers for Medicare & Medicaid Services (CMS) and Social Security Services Administration (SSA)  who work on Medicare Secondary Payer compliance.  CMS contractors that work on Medicare Secondary Payer Compliance are not impacted and …
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Blog, Medicare Secondary Payer News, Medicare Set Aside

Today, the Centers for Medicare & Medicaid Services has submitted for review to the Office of Management & Budget (OMB) two important reviews the Industry has waited for with regard to Medicare Secondary Payer Compliance.  The OMB is being asked to approve a Notice for Proposed Rule Making with regard to how CMS expects its interest with regard to future …
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LMSA Rulemaking Coming?

31 Jul 2013 Jeff Signor No Comments

Blog, LMSA

Medicare Plans to issue a Notice of Proposed Rule Making with regard to protecting Medicare’s interest in a liability case this coming September.  Click here: http://tinyurl.com/mmed9tr.  According to the regulatory calendar, the Centers for Medicare & Medicaid Services (CMS) is poised to issue the rule which would allow stakeholders a period of 60 days before it would move toward the final rule …
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Blog, WCMSA

CMS has published a “Helpful Hint” document which outlines areas of WCMSA submissions that frequently become an obstacle.  CMS explores the following twelve areas:  Incomplete Medical records for the last two years of treatment  Exclusion of pertinent medical records or submitting too many records.  Insufficient proof of medications, dosages and frequencies for the last two years of treatment.  Carrier payments …
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