Posts Tagged ‘CMS’
Medicare & The Upside Down (Case)
Sometimes we refer to a case where fees and costs exceed settlement as “upside down.” An Indianapolis firm asked us: can a Medicare Plan (meaning Medicare Advantage or Medicare Supplemental Plan) claim a lien in the upside down world? No. Medicare Advantage Plan liens claim their rights exist from the same laws that allow Medicare…
Read MoreCRC Transition Begins Today (February 7, 2018)
Please remember Medicare liens for what it considers No-Fault and Workers’ Compensation files may not change for a few days. Performant Recovery, Inc. officially takes over tomorrow, February 8, 2018; however, CGI is handing off all data beginning today, February 7, 2018. All CRC files will re-start processing (mail, faxes, etc.) on Monday, February 12, 2018.…
Read MoreCRC Transition Days – February 7 – 9, 2018
As we’ve previously discussed, Medicare’s CRC contractor is changing from CGI to Performant Recovery, Inc. on February 8, 2018. The CRC is having three days of what it is calling it’s, “Dark Days” from February 7 thru 9, 2018. What does this mean? Medicare No-Fault and Workers’ Compensation files will be accessible, but, no additional…
Read MoreCMS’s New Medicare Set-Aside Contractor
CMS can finally move forward with its new Medicare Set-Aside (“MSA”) contractor. While that contract was awarded in September, two organizations challenged that award arguing that CMS “unreasonably failed to permit offerors to make oral presentations and failed to conduct discussions.” More interesting, Arch Systems, LLC argued that the agency “failed to reasonably evaluate the…
Read MoreNew CMS Contractor Coming February 2018
The Centers for Medicare & Medicaid Services (CMS) has announced that a new Commercial Repayment Center (CRC) Contractor, Performant Recovery, Inc. will take over CRC duties on February 8, 2018. Performant will assume responsibility for conditional payment recoveries from no-fault insurers and workers’ compensation entities. CMS will be presenting webinars on the transition on January…
Read MoreLiability MSAs on the Horizon. Will they or won’t they?
If you feel like CMS is treating Liability Medicare Set-Asides like a Sitcom love story, you’re not alone. Like the transition to ICD-10 and the implementation of Mandatory Insurer Reporting, the “will they or won’t they” of LMSAs is years in the making. CMS gave us a great cliffhanger…
Read MoreConnections between Medicare & Medicare Advantage Plans
Medicare (CMS, BCRC, CRC, or any other contractor) does not speak for Medicare Advantage Plans (“MA Plans”). MA Plans do not speak for Medicare. These two statements could not be more important as MA Plan providers like Humana become more aggressive in suing to enforce their Medicare Part C liens. Last week, an attorney asked…
Read MoreWhat About LMSAs? CMS Postpones Guidance
The Centers for Medicare & Medicaid Services (“CMS”) continues their progress towards building a process for Liability Medicare Set-Asides (“LMSAs”) and No-Fault MSAs (“NFMSAs”). With that said, CMS has been unable to issue regulations to move the process forward. First, CMS issued MLN Matters Number SE17019 on September 19, 2017. That MLN Matters transmittal was…
Read MoreCMS Awards New MSA Review Contract
CMS has awarded its massive Workers’ Compensation Review Contractor (WCRC) for a whopping $60,759,236.00 to Capitol Bridge, LLC. This contract is nearly $12,000,000 larger than that awarded to Provider Resources, Inc. for the 2011 contract (PRI’s contract award was initially for approximately $24,000,000.00; however, that amount doubled to $48,000,000.00…
Read MoreMedicare Advantage Liens – Your Law Firm’s Responsibility
Humana is continuing to show the strong position it holds for reimbursement of its Medicare Advantage Plans. We posted on this topic 18 months ago when Humana sued the Paris Blank law firm for failing to reimburse it from a PI settlement. On August 18, Humana filed two more…
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