Centers for Medicare & Medicaid Services (CMS)

As another new year settles in, we know at least one thing is certain: Medicare Secondary Payer (MSP) compliance will continue to present formidable challenges for claims…

In response to CMS awarding the WCRC bid to Capitol Bridge, LLC, KEN Consulting Inc. and Arch System, LLC filed formal bid protests with the Government Accountability…

Whether liability Medicare set-asides (LMSAs) are legally “required” continues to be a vexing question for parties settling liability claims.

Spurred by a number of favorable court decisions allowing MAPs to sue for “double damages” under the MSP statute, Medicare Part D plans are now beginning to step into the…

For years, the Centers for Medicare and Medicaid Services (CMS) has refused to consider medical evidence postdating the original submission date of a Workers’…

Opana ER will be voluntarily removed from the marketplace, per the announcement last week of manufacturer Endo International plc.

The fight against opioids continues, as the U.S. Food and Drug Administration recently announced they want painkiller Opana ER off the market. If removed, learn how it…

The Arkansas Legislature quickly moved a relatively unknown bill addressing workers’ comp settlements in the final days of its 2017 legislative session.

Zero WCMSA submissions are getting mired in a cycle of CMS development letters & submissions as the WCRC gets more meticulous about submitted pay histories.

The SPARC Act seeks to ensure that Medicare Part D is adequately reimbursed when another entity is determined to be the primary payer.

Shawn Deane, vice president of Medicare / Medicaid compliance and policy, has been elected president of the National Alliance for Medicare Set-Aside Professionals.

In CIGA v. Burwell, the court ruled the CMS practice of seeking full reimbursement of a medical provider's single charge was improper under the MSP statute.

There are two main categories of Medicare compliance: (1) reporting and (2) recovery. Although the law and regulations clearly state what must be done in each category…

Medicare Set-Asides (MSAs) are primarily a coordination of benefits tool. The failure to obtain & adequately fund an MSA can result in a denial of payment.

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