Centers for Medicare & Medicaid Services (CMS)
Big reforms are coming to Michigan PIP - How the changes will impact Medicare Secondary Payer compliance
On 5/30/19, Governor Gretchen Whitmer signed Michigan Senate Bill 1, which makes significant changes to Michigan’s personal injury protection (PIP) system.
Reality check: Debunking the myths of Medicare Secondary Payer compliance
MSP is a challenging area of compliance for which federal law, regulations, and policy don’t always provide clear answers. It’s vital to understand fact vs fiction.
Workers’ Compensation Medicare Set Aside Legislation Filed, Referred to Committee
On June 18, 2018, Senators Rob Portman (R-OH) and Bill Nelson (D-FL) introduced legislation aimed at reforming the Centers for Medicare and Medicaid Services’ (CMS)…
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: MSP compliance will continue to present formidable challenges for claims payers.
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…
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.
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…
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’…
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.
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…
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.
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.
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.
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.
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.