Category Archives: Medicare Secondary Payer News

Blog, Medicare Secondary Payer News, Medicare Set Aside, WCMSA

We recently blogged that CMS delayed the Workers’ Compensation Review Contractor (the entity that reviews Workers’ Compensation Medicare Set-Asides) award to the 2ndquarter of 2017, with the solicitation being released in the 1st quarter. For our prior blog, click here. CMS has now released their draft Request for Proposal (RFP) as well as draft Statement of Work (SOW) for the Contractor.  While it is …
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CMS Reduces MSP Liability Threshold for 2017 to $750

05 Dec 2016 Heather Sanderson No Comments

Blog, LMSA, Medicare Secondary Payer News, Medicare Set Aside

Yesterday, CMS announced that the threshold for liability settlements will reduce to $750. CMS will also maintain the $750 threshold for no-fault and workers’ compensation settlements, where the no-fault insurer or workers’ compensation entity does not otherwise have ongoing responsibility for medicals. To read CMS’ Alert click here. For CMS’ methodology in determining its 2017 thresholds, click here. Recall that …
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Blog, Medicare Jurisdiction, Medicare Secondary Payer News

A few months ago, we issued a blog regarding MSP private cause of action litigation against a Plaintiff attorney law firm for failure to reimburse the MAP its conditional payments (Humana v. Paris Blank LLP). For our prior blog on this case, click here. The Paris Blank matter has now settled and the parties are subject to a confidentiality provision.  …
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Blog, Legal/Legislative News, Medicare Jurisdiction, Medicare Secondary Payer News, Pharma Part D, Reimbursements

The Medicare Advocacy Recovery Coalition (MARC) worked diligently over the past eighteen months to develop and introduce the Secondary Payer Advancement, Rationalization and Clarification Act of 2016 (SPARC). Representatives Tim Murphy (18th District Pennsylvania, Republican) and Ron Kind (3rd District Wisconsin, Democrat) sponsored this bipartisan legislation that was immediately referred to the two committees of jurisdiction over Medicare – House …
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CMS Delays WCRC Award to 2nd Quarter of 2017

06 Oct 2016 Heather Sanderson No Comments

Medicare Jurisdiction, Medicare Secondary Payer News

Just last month, CMS issued an updated timeframe Request for Proposal (RFP) for a new Workers’ Compensation Review Contractor (WCRC) bid. This last update stated that the proposal would be released in October 2016, with an award being granted in February 2017. For our prior blog, click here. However, CMS has again updated/delayed their pre-solicitation notice to state that the solicitation …
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Commercial Repayment Center (CRC) Update

01 Jun 2016 Heather Sanderson No Comments

Blog, Medicare Conditional Payments, Medicare Secondary Payer News

Three months ago, we issued a blog (click here to view) regarding the CRC beginning to issue Conditional Payment Notices (CPNs) and Demands on no-fault and workers’ compensation claims where Ongoing Responsibility for Medical (ORM) had been reported. Recall that back on October 1, 2015, the CRC began to share a portion of the Non Group Health Plan (NGHP) recovery …
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CMS Issues Alert on ICD-9 and ICD-10 Exclusions

25 May 2016 Heather Sanderson No Comments

Blog, Medicare Reporting Section 111, Medicare Secondary Payer News

The Centers for Medicare and Medicaid Services (CMS) released a technical alert dated May 23, 2016 related to Non-Group Health Plan (NGHP) MMSEA Section 111 reporting. This alert communicates that there are newly excluded ICD diagnosis codes that will no longer be accepted by CMS beginning on January 7, 2017.  The exclusion includes codes from both the ICD-9 and ICD-10 revisions as follows:  ·         ICD-9-CM o   999.9 (Other …
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Blog, Legal/Legislative News, Medicare Jurisdiction, Medicare Secondary Payer News, Trial Practice

In an opinion out of the U.S. District Court for the Middle District of Pennsylvania, Mikiewicz v. Hamorski and Erie Insurance Exchange, 2016 U.S. Dist. LEXIS 58859 (May 3, 2016), the Defendant Erie Insurance Exchange (“Erie”) removed the Plaintiff Helen Mikiewicz’s (“Plaintiff”) auto accident litigation to Federal Court. Erie had initiated removal to Federal Court due to the fact that …
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Blog, Legal/Legislative News, Medicaid Third Party Liability Recoveries, Medicare Jurisdiction, Medicare Secondary Payer News, Trial Practice

In an unpublished opinion out of Illinois, McKim v. Southern Illinois Hospital Services, the issue litigated was whether certain government benefit program liens (e.g., Medicare and Medicaid) were capped by state lien law. As expected, the court disagreed, finding that Federal preemption entitled governmental plans like Medicare, Medicaid and Part D to not be subject to limitations imposed by state …
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Commercial Repayment Center Issuing Demands on WC/NF Claims

14 Mar 2016 Heather Sanderson No Comments

Blog, Medicare Conditional Payments, Medicare Jurisdiction, Medicare Reporting Section 111, Medicare Secondary Payer News

The Commercial Repayment Center (CRC) took over a portion of the non-group health plan conditional payment recoveries on October 1, 2015. The CRC is charged with recoveries where the identified debtor is the insurance carrier and CMS has been notified via Section 111 reporting of a primary payer. The Benefits Coordination and Recovery Contractor (BCRC) continues to pursue recoveries where …
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