CMS
Liability Medicare Set-Aside Requirements
The General “Requirements” of an LMSA: A Technical Review Medicare Set-Asides (“MSA”) cannot exist without Medicare’s right to reimbursement first being stated in the law. Those rights arise from the Medicare Secondary Payer Statute, 42 U.S.C. § 1395y(b)(2) (“MSP”) and 42 C.F.R. 411 et. seq. Then we must note that, MSP regulations and Centers for…
Read MoreTexas PI Firm Sued for Failure to Pay Medicare Lien
The US Attorney’s Office has filed suit against another personal injury law firm for failing to pay a Medicare lien. Previous similar actions have been settled with firms in the northeast and Atlantic coast that ignored liens. This time, the law firm paid something to Medicare, but tried to reduce the lien using improper, non-administrative…
Read MoreMedicare to Pay for Acupuncture to Lower Opioid Use
CMS announced a coverage determination that will allow Medicare to pay for acupuncture that treats chronic low back pain. This new coverage is highly consequential in the legal industry as the stated purpose is to expand options that reduce opioid use. Opioids just so happen to be a major expense in Medicare Set-Asides (MSAs). Health…
Read MoreCMS Recovery Thresholds Create Safe Harbor
CMS has maintained Medicare lien minimum recovery thresholds for the fourth straight year. These minimum settlement amount recovery thresholds essentially create a safe harbor for the smallest of settlements (except if those settlements are exposure-based injuries). You can find that CMS alert here. Here are some highlights: Plaintiffs need not report settlements less than $750;…
Read MoreMed Lien Solutions Announces Acquisition of Med Max USA
Detroit, MI September 10, 2018: For Immediate Release Med Lien Solutions announced today the acquisition of Med Max USA, a nationwide provider of settlement services, creating a unified medical and subrogation services solution available to everyone in the legal, medical, and insurance industries. The company will operate under the new name Massive. “Our lien resolution…
Read MoreCMS and Liability Medicare Set-Asides
CMS’s newest time frame to create a Liability Medicare Set Aside (“LMSA”) process has come and gone. Again. We’ve seen CMS make multiple attempts to create a process and then pull them back. CMS’s Liability Medicare Set-Aside History In 2012, CMS issued an Advanced Notice of Proposed Rulemaking (“ANPR”) requesting comment on potential rules; CMS…
Read MoreFinding Hidden Coverage: The PAID Act
Did you know that Medicare has data on its beneficiaries’ Medicare Advantage Plans, Medicare Supplemental Plans, Medicare Part D Drug Plans, and even Medicaid coverage? Currently, CMS does not provide that additional coverage information to either plaintiffs (and their attorneys) or defendants in the Non-Group Health Plan realm. The Medicare Advocacy Recovery Coalition (“MARC”) is…
Read MoreCMS Update on Regional Office Move
Update from CMS: The Philadelphia Regional Office is Moving Keeping you up to date on all things CMS! The Centers for Medicare & Medicaid Services (CMS) has announced that the Philadelphia, PA Regional Office is moving. The new contact information is below: 801 Market Street Suite 9400 Philadelphia PA 19107-3132 215-861-4178 If you need assistance…
Read MoreNew Contractor Set to Take Over MSA Reviews
Medicare’s new Workers’ Compensation Review Contractor (“WCRC”) is set to take over all Medicare Set-Aside (“MSA”) reviews on Monday, March 19, 2018. The new contractor, Capitol Bridge, LLC, has stated it expects no changes to the process or timeframes for review. It has provided new contact information though: WCRC New Phone: 833-295-3773 WCRC New Email: [email protected]…
Read MoreMedicare Numbers Transition: Begins April 1
Medicare is finally transitioning its beneficiary ID numbers (known as Health Insurance Claim Numbers, or, HICNs) beginning April 1, 2018. This change is required by a 2015 law, and Medicare first announced this transition nearly a year ago on May 31, 2017. See our previous blog post on this topic by clicking here. How will the…
Read More