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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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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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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CRC 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.…

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CMS’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…

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Liability 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…

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What 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…

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CMS Begins Teaching Providers About MSAs

CMS issued MLN Matters Number SE17019 on September 19, 2017. Its three pages have one clear intent: teach medical providers how to discover whether they should bill Medicare or the patient’s MSA account. Click here for the full text of MLN Matters Number SE 17019. The article concludes with a section called, “Provider Action Needed.”…

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CMS 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…

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Medicare Set-Asides are No Longer Set in Stone

The Centers for Medicare & Medicaid Services (CMS) has long followed a clear path toward revising MSAs: You couldn’t. CMS has finally changed its tune. Its newest Workers Compensation Medicare Set-Aside User Guide lays out those changes. First – let’s review the soon-to-be-forgotten, defunct MSA re-review process. The old process did not allow re-review where…

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