Category Archives: Medicare Secondary Payer News

Blog, Legal/Legislative News, Medicare Conditional Payments, Medicare Secondary Payer News, Pharma Part D

Several of our clients have been experiencing an increase in conditional payment letters from Medicare Part D prescription drug plans. Historically, Part D plans have been less active in recovery of conditional payments than traditional Medicare or Medicare Advantage Part C plans; however, the tide appears to be changing. Why are Part D Plans recently increasing their recovery efforts? One …
READ MORE

Blog, Franco Signor News, Medicare Secondary Payer News

2019 has been a particularly active year with regard to enforcement of the Medicare Secondary Payer Act (MSP). The rulemakings on Liability Medicare Set-Asides (LMSAs) and Section 111 penalties are on schedule to be issued in September of this year. Further, the industry has experienced an increase in Medicare Advantage and Part D recoveries, as well as an increase in …
READ MORE

About Franco Signor, Blog, Franco Signor News, Legal/Legislative News, Medicare Secondary Payer News

Originally published in CLM Magazine April 2019 Edition Following the Rules: Proposed Rules Aim to Clarify Enforcement of Medicare Secondary Payer Compliance In December 2018, two (2) notices were posted on the Office of Management and Budget (OMB) website signaling that the Department of Health & Human Services (DHHS)/Centers for Medicare & Medicaid Services (CMS) plans to move forward with …
READ MORE

Blog, Legal/Legislative News, Medicare Jurisdiction, Medicare Reporting Section 111, Medicare Secondary Payer News

The Medicare Advocacy Recovery Coalition (MARC) has announced that the Provide Accurate Information Directly (PAID) Act was introduced yesterday, February 27, 2019 in the U.S. House of Representatives as H.R. 1375 by lead Co-Sponsors Reps. Ron Kind (D-WI) and Gus Bilirakis (R-FL). Representatives Kind and Bilirakis have sponsored this bipartisan legislation to improve the Medicare Secondary Payer Act (MSP). PAID’s …
READ MORE

Blog, Legal/Legislative News, Medicaid Third Party Liability Recoveries, Medicare Secondary Payer News

The following article was co-written by: Roy Franco, Chief Client Officer and Matthew Newman, Associate Compliance Counsel A U.S. District Court’s ruling regarding MSP Recovery LLC’s recent filings in State Court has raised concerns about a possible Medicaid Third Party Liability recovery strategy.  The situation involves an archaic discovery mechanism (“bill of pure discovery”) that would allow MSP Recovery LLC …
READ MORE

Blog, Medicare Reporting Section 111, Medicare Secondary Payer News, RRE

The Centers for Medicare & Medicaid Services (CMS) has issued yet another abundantly clear signal that Medicare Secondary Payer (MSP) enforcement will be a priority in 2019. Just last week, we blogged that a Proposed Rule on a voluntary review process for Liability Medicare Set-Asides (LMSAs) would be issued by September 2019. Now, an additional notice on the Office of Management and …
READ MORE

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 …
READ MORE

Blog, Medicare Secondary Payer News, Pharma Part D

Recently, CMS updated its Part D Manual to include specific changes to the Manual’s Medicare Secondary Payer (MSP) provisions.  The updated manual can be found here. Page 40 now provides: “Part D sponsors are responsible for adjudicating enrollees’ claims in accordance with MSP requirements. Under CMS’ adjudication logic for Part D MSP claims, the provider/pharmacy receives at least the Part …
READ MORE

Blog, Legal/Legislative News, Medicare Advantage Part C, Medicare Jurisdiction, Medicare Secondary Payer News

Reprinted from the Morning Consultant In health policy, the minutia is not trivial; it’s essential. Small incentives created by policymakers can have a significant impact upon how Medicare beneficiaries, doctors, hospitals and insurers respond to health care claims. But sometimes policies — even the most well-intentioned — can have unintended consequences, leading to wasted resources, burdensome regulations and broken promises …
READ MORE

About Franco Signor, Blog, Medicaid Third Party Liability Recoveries, Medicare Secondary Payer News

Originally published in the June 2018 Issue of CLM Magazine TIME TO GET PAID In 1965, President Johnson signed into law the Medicaid program, establishing the state-based healthcare safety net system in place today. Although since that time Congress has undertaken dozens of efforts to streamline and improve Medicaid, historically there has not been considerable focus to improve states’ Medicaid …
READ MORE

© 2012-2017 Franco Signor LLC