Category Archives: WCMSA

Blog, Legal/Legislative News, Medicare Set Aside, WCMSA

We have blogged on numerous occasions regarding Workers’ Compensation Medicare Set-Aside (WCMSA) legislation that continues to be re-introduced in Congress with slight variations over the last decade (hereinafter referred to as “WCMSA Bill”). Our 2018 blog on the prior WCMSA Bill can be found here. The current 2019 proposed WCMSA Bill can be found here. This year, the WCMSA Bill …
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Blog, WCMSA

Earlier this year, we blogged about CMS updating its WCMSA Reference Guide. Specifically, we pointed out that CMS for the first time included explicit examples in which the settlements would not meet CMS’ Review Threshold for review of a proposed WCMSA, but which would still require consideration of Medicare’s interests. The first example involved an under-threshold Medicare beneficiary settlement, and …
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CMS Updates WCMSA Reference Guide and NGHP User Guide

09 Jan 2019 Heather Sanderson No Comments

Blog, Medicare Set Aside, WCMSA

Yet another indication that The Centers for Medicare & Medicaid Services (CMS) intends to make Medicare Secondary Payer (MSP) enforcement a priority in 2019: both the WCMSA Reference Guide and NGHP User Guide have been updated with several impactful changes. The updated WCMSA Reference Guide can be found here, and the updated NGHP User Guide can be found here. WCMSA …
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Blog, Medicare Secondary Payer News, Medicare Set Aside, Pharma Part D, WCMSA

What is the intended purpose behind a Workers’ Compensation Medicare Set-Aside (WCMSA)? The WCMSA Reference Guide, Section 3.0 states: “A WCMSA allocates a portion of the WC settlement for all future work-injury-related medical expenses that are covered and otherwise reimbursable by Medicare (“Medicare covered”) (emphasis added). Accordingly, Medicare through its issued guidance has provided that medical expenses should not be …
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Administration, Blog, Legal/Legislative News, Medicare Set Aside, WCMSA

For numerous years, a slightly varied version of essentially the same proposed legislation regarding Workers’ Compensation Medicare Set-Asides (WCMSAs) continues to be re-introduced in Congress (hereinafter referred to as “MSA Bill”). Just last week, the MSA Bill was again introduced in the Senate. It is titled “Medicare Secondary Payer and Workers’ Compensation Settlement Agreements Act of 2018.” A copy of …
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Settlement Contingent Upon CMS Approval of WCMSA: Problematic?

08 May 2018 Heather Sanderson No Comments

Blog, Legal/Legislative News, Medicare Secondary Payer News, WCMSA

A decision just issued out of the Third Circuit Court of Appeal in Louisiana demonstrates the various nuances and obstacles that may be present when entering into a workers’ compensation settlement contingent upon CMS approval of a WCMSA. In Ortega v. Cantu Servs., Inc. 2018 La. App. LEXIS 845 (May 2, 2018), the claimant, a Medicare beneficiary, settled her disputed …
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Blog, Medicare Set Aside, WCMSA

Version 2.7 of the Workers’ Compensation Medicare Set-Aside (WCMSA) Reference Guide has been released as of March 19, 2018. It can be found here. The two minor changes are the following: An updated phone number for the Workers’ Compensation Review Contractor (WCRC). The new phone number is (833) 295-3773. See section 14.0 (pg. 51), Appendix 1 (pg. 61) and Appendix 5 (pg. 84). …
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Blog, Medicare Secondary Payer News, WCMSA

Yesterday, March 7th, the Centers for Medicare & Medicaid Services (CMS) conducted a webinar to discuss the transition of the new Workers’ Compensation Review Contractor (WCRC) from Provider Resources to Capitol Bridge LLC. Below is a summary of the relevant points of the webinar.  Timing of Transition: Capitol Bridge LLC will fully take over on March 19, 2018. New Contact Information: The …
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Blog, Medicare Set Aside, WCMSA

Click here to read the full announcement. The webinar is scheduled for Wednesday, March 7, 2018 at 1:00 pm ET.

Blog, Legal/Legislative News, LMSA, Medicare Conditional Payments, Medicare Set Aside, WCMSA

The United States District Court for the District of New Mexico has issued an interesting decision involving the uncertainty for the need of a Liability Medicare Set-Aside (LMSA) in a medical malpractice settlement involving a Medicare beneficiary. The case is captioned Silva v. Burwell, 2017 U.S. Dist. LEXIS 195032 (November 28, 2017). A copy of the decision can be found …
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