Category Archives: WCMSA

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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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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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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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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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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