Category Archives: Blog

Blog, Medicare Advantage Part C, Pharma Part D

The Medicare Advocacy Recovery Coalition (MARC) is an organization made up of insurance companies, third party administrators, defense firms, plaintiff firms and MSP compliance companies. MARC recently announced an important new legislative initiative. Primary Plans which are plagued unfairly by MSP private cause of action claims would have an important tool at their disposal, once the legislation is introduced and …
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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, Legal/Legislative News, Medicare Advantage Part C, Trial Practice

The U.S. District Court for the Southern District of Texas has issued an opinion in ongoing litigation by Aetna and Humana, both Medicare Advantage Plans (MAPs), against a Plaintiff law firm that represented asbestos trusts. The allegation by Aetna and Humana (“Plaintiffs”) is that Defendant Shrader Associates LLP (“Schrader”) represented at least fifteen “Matched claimants” that received coverage from the …
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Blog, Legal/Legislative News, Medicare Advantage Part C

Primary Plans Beware: The tide continues to turn across the country in favor of Medicare Advantage Plans (MAPs) having a right to sue primary plans based on the Medicare Secondary Payer (MSP) private cause of action and the ability to seek double damages for the failure to reimburse MAP conditional payments. The decision has the potential to extend the law …
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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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About Franco Signor, Blog, LMSA, Medicare Secondary Payer News

This article was originally published in the March 2018 issue of CLM Magazine. A CMS Framework is Coming – Are You Involved?  (A CLM Magazine Article by Roy Franco and Heather Sanderson) For many years, Liability Medicare Set-Asides (LMSAs) have been a hot topic for discussion due to the potential challenges that a Centers for Medicare & Medicaid Services’ (CMS) LMSA review …
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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, Medicaid Third Party Liability Recoveries

As we have discussed in numerous blogs and webinars, Medicaid Third Party Liability (TPL) operates at a state level. For a more detailed explanation on Medicaid TPL, click here. In summary, the Centers for Medicare & Medicaid Services (CMS) has required each state to implement TPL legislation and regulation surrounding the recovery of medical payments made by Medicaid, where a …
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Blog, Medicare Conditional Payments

Just a reminder that the new Commercial Repayment Center (CRC) contractor goes live today. Click here to read our recent blog on the topic. Click here to download a CRC – NGHP Correspondence Cover Sheet.

About Franco Signor, LMSA

Click here to register to view the recording. Join Roy Franco and Heather Sanderson for their first live/video webinar event on January 31st at 1:30 PM EST. Roy and Heather will be taking on the hot topic of LMSAs, and what payers should be doing right now to gear up for the likelihood of CMS introducing a review policy for …
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