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Centers for Medicare & Medicaid Services (CMS)

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February 28, 2018

Medicare watch list: Staying ahead of the Medicare Secondary Payer compliance curve

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…

Bid
December 15, 2017

GAO denies WCRC bid protests

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…

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December 1, 2017

Court declines to rule on whether LMSA is necessary - Cites no legal authority for MSAs in liability cases

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

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November 27, 2017

Medicare Part D - The next recovery frontier?

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…

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November 20, 2017

The CMS WCMSA "Amended Review process" - New opportunity to reduce WCMSA allocations and settle claims

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

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July 17, 2017

Opana ER will be removed from the marketplace

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

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June 26, 2017

FDA request to remove Opana ER may be good news for WCMSAs

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…

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April 13, 2017

Arkansas passes bill affecting future medical benefit settlements for Medicare beneficiaries

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

0msa
April 4, 2017

Break the logjam of zero MSAs in development

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

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March 23, 2017

SPARC Act reintroduced in Congress

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

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February 17, 2017

Shawn Deane will lead industry initiatives as president of NAMSAP

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

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January 10, 2017

Breaking: CMS recovery practice ruled improper under the MSP

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.

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September 19, 2016

The compliance gap: How you see your compliance vs. how Medicare sees it

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…

Binders
September 16, 2016

Should you purchase MSA liability insurance?

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.

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August 18, 2016

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.