Kate Riordan

1/18/2017 - 5 min read

Important SSNRI news at CMS forum

To comply with the Medicare Access and CHIP Reauthorization Act of 2015, CMS announced the Social Security Number Removal Initiative on Tuesday, January 17.

9/29/2016 - 3 min read

The SPARC Act may have implications for future Medicare Advantage Plan rulings

On September 22, Congressmen Tim Murphy (R-PA) and Ron Kind (D-WI) introduced legislation designed to clarify the Medicare Secondary Payer (MSP).

8/18/2016 - 4 min read

MSP statute extends its reach in the 11th Circuit: Foreshadowing for liability MSAs?

Undoubtedly, the 11th Circuit Court decision in Humana has obvious financial consequences to insurers.

8/17/2016 - 4 min read

The impact of Medicare Advantage Plans on your claims: The risk of double damages and summary judgment

The decision will have a significant impact on liability, workers compensation, and no-fault claims being handled.

5/9/2016 - 3 min read

Untangling the confusion of Accident & Health policies

Medicare compliance often requires that different policy types be grouped together into one set of claims. It’s the practice of the Centers for Medicare & Medicaid Services (CMS) to pigeonhole non-group health plans (NGHP) into either workers' compensation, liability, or no-fault.

3/6/2016 - 2 min read

Medicare Secondary Payer implication indicated in proposed 2017 budget

The President’s fiscal year (FY) 2017 budget, which starts October 1, 2016, proposes $4.1 trillion in spending. Of this, an estimated $1.0 trillion in mandatory and discretionary outlays is earmarked for the Centers for Medicare and Medicaid Services (CMS).

11/16/2015 - 3 min read

California becomes fifth state to require closed drug formulary for workers' compensation claims

California Governor Jerry Brown has signed Assembly Bill No. 1124, which mandates that the Division of Workers’ Compensation (DWC) implement a prescription drug formulary by July 1, 2017.

Linkedin Sales Navigator H5cptwuvhm Unsplash

5/19/2015 - 2 min read

California’s independent medical review: Pursuing necessary and appropriate care

California uses Independent Medical Reviews (IMRs) to resolve disputes regarding medical treatment for injured employees. This process was enacted by way of a landmark workers' compensation reform, Senate Bill 863. The bill, which took effect January 1, 2013, implemented specific cost-saving efficiencies for employers, among other objectives.

4/15/2015 - 4 min read

Medicare Advantage strikes again: Humana v. Western Heritage

The last few years have seen several key cases regarding the evolving issue of what rights Medicare Advantage organizations (MAOs) have when seeking recovery in a primary payer situation. In particular, MAOs are increasingly seeking federal court — and the Medicare Secondary Payer (MSP) statute’s double damages provision — as the means to recover.

2/20/2015 - 1 min read

ICD-10 update

One of the most important developments in Medicare Secondary Payer compliance for 2015 will be the transition from ICD-9 codes to ICD-10 codes on October 1, 2015. On that date, medical providers will begin using ICD-10 codes.

10/14/2014 - 2 min read

Court allows Medicare Advantage plan’s suit for double damages to proceed

In an important development on the Medicare Advantage (MA) front, the court in Humana v. Farmers Texas County Mutual Insurance Company, et. al, No. 13-CV-611-LY (W.D. Texas, September 24, 2014) issued a ruling allowing a Medicare Advantage plan’s lawsuit for “double damages” to proceed.

Kate Riordan, J.D.

Important SSNRI news at CMS forum

The SPARC Act may have implications for future Medicare Advantage Plan rulings

MSP statute extends its reach in the 11th Circuit: Foreshadowing for liability MSAs?

The impact of Medicare Advantage Plans on your claims: The risk of double damages and summary judgment

Untangling the confusion of Accident & Health policies

Medicare Secondary Payer implication indicated in proposed 2017 budget

California becomes fifth state to require closed drug formulary for workers' compensation claims

California’s independent medical review: Pursuing necessary and appropriate care

Medicare Advantage strikes again: Humana v. Western Heritage

ICD-10 update

Court allows Medicare Advantage plan’s suit for double damages to proceed