Exhaust Administrative Remedies Before Challenging Medicare Conditional Payment Claims

A new case out of Missouri reaffirms this important principle: When challenging Medicare conditional payment claims, parties must exhaust Medicare administrative appeals before filing an action in federal court. This issue recently reappeared in Fortner v. Price (Secretary of Health and Human Services), 2017 WL 117712 (E.D. Missouri, March 30, 2017), a case in which […]

Clues to CMS future gleaned from WCRC solicitation notice

The Centers for Medicare & Medicaid Services (CMS) moved forward with requests for proposal regarding the Workers’ Compensation Review Contractor (WCRC) contract by releasing a full solicitation notice before the holidays. Because the request is for a five-year contract, the solicitation information can provide clues to CMS’s long-term strategy regarding Medicare Set-Asides (MSAs). Insights into […]

Important SSNRI News at CMS Forum

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires the Centers for Medicare & Medicaid Services (CMS) to remove Social Security numbers (SSNs) from Medicare cards before the end of the decade. To comply with MACRA, CMS created the Social Security Number Removal Initiative (SSNRI). On Tuesday, January 17, CMS held an Open […]

New Report Reveals Medicare’s “Low-Dollar” Threshold Calculations

U.S. Secretary of Health and Human Services (HHS) Sylvia Mathews Burwell released a new report to Congress that provides insight into the data the Centers for Medicare and Medicaid Services (CMS) used to calculate and substantiate its threshold figures. The report explains how Medicare calculated its recently revised “low-dollar” recovery and reporting thresholds for liability, […]

Removing Roadblocks to Settlements: Medicare Part C Claims in the Way of Your Settlement

The last half-dozen years have seen Medicare Secondary Payer (MSP) compliance evolve, with the most recent example being its change in focus from mandatory insurer reporting to rolling recovery. But one of the most impactful changes involves Medicare Advantage Organizations (MAOs). Ten years ago, most practitioners didn’t even worry about them, but now insurers in […]

CMS to Hold Town Hall Call on November 17

The Centers for Medicare and Medicaid Services (CMS) will conduct a Town Hall Teleconference November 17, 2016 (1:00 p.m. – 2:30 p.m. EST) to address numerous liability insurance (including self-insurance), workers’ compensation, and no-fault claims issues.  Click here to view CMS’s full notice and call-in instructions. CMS noted that it expects to discuss: Ongoing Responsibility […]