Court Blocks Medicare Discovery Requests – Ruling limits insurer’s ability to determine MMSEA obligations

A new case out of Connecticut highlights complications insurers can encounter in obtaining information to assess their Medicare Secondary Payer (MSP) compliance obligations. In Silver v. Milford Medical Center Associates, 2017 WL 2452551 (Conn. Super. Ct. May 11, 2017), the court denied the defendant’s motion to file supplemental discovery requests to procure Medicare related information. […]

Fact Check Time for LMSA/NFMSA Developments

It is no secret that CMS has announced (for years) its intention to expand the workers’ compensation MSA program into the liability and no-fault arena. But the real question today is: What, when, and how is CMS going to step into this new arena and how will it affect claims management? CMS has provided little […]

New Ruling: Court Expands upon Its Recent Ruling Limiting CMS Recovery Rights

The court in CIGA v. Price, 2017 WL 1737717 (C.D. California, May 3, 2017) has expanded upon its prior order limiting Medicare’s conditional payment rights. The case has garnered much industry attention, given its potential impact on the Centers for Medicare & Medicaid Services (CMS) recovery claims. The Case In this action, CIGA challenged CMS’ […]

3 Easy Ways to Reduce MSA Prescription Costs

With prescription prices increasing every day, it’s harder than ever to contain costs. That’s why we put together three easy ways to reduce Workers’ Compensation Medicare Set-Aside (WCMSA) costs.[1] 1. Split the difference on dosages Splitting higher dosages into multiple lower dosages can really cut costs. Take gabapentin, the generic form of Neurontin. Often prescribed […]

Break the Logjam of Zero MSAs in Development

Zero WCMSA submissions are getting mired in a cycle of CMS development letters and responses, as the CMS Workers’ Compensation Review Contractor (WCRC) becomes increasingly meticulous about formatting requirements for submitted pay histories. Many of the current WCRC reviewer requests are not even listed requirements in either the WCMSA reference guide or the CMS operating […]

CMS Will Use the New 2012 CDC Life Table for WCMSAs

On March 8, 2017, the Centers for Medicare and Medicaid Services (CMS) announced that beginning April 1, 2017, it will use the new 2012 CDC Life Table to calculate life expectancies in Workers’ Compensation Medicare Set-Asides (WCMSAs). The table correlates a person’s age with anticipated life expectancy, so CMS uses it to determine the appropriate […]