Lien Resolution & MSP Compliance CLE *register today*

Join us tomorrow as we partner with Ametros & WILG to learn* about solutions in claims resolution, MSP compliance, and professional administration. *CLE Credit available in selected states. Topics will include: • New Requirements in Medicare Consent to Release Forms: Beginning on April 1, 2020, the Centers for Medicare & Medicaid Services (CMS) will require…

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Liability Medicare Set-Aside Requirements

do you need an msa

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…

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Medicare to Pay for Acupuncture to Lower Opioid Use

medicare to pay for acupuncture

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…

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CMS 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;…

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CMS 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…

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Finding 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…

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CMS 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…

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New 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]

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Medicare 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…

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Medicare Reporting Guidelines – 2018 Update

CMS has released its annual SMART Act report to Congress. The report includes the usual updates you’d expect, namely, cost of recovery data and reporting thresholds. Reporting Thresholds First, CMS has updated 2018 Mandatory Insurer Reporting and plaintiff-settlement reporting thresholds. Any settlement below these amounts needs not be reported by defendants (or, “primary payers”) and…

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