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Settlement

Josh Appel Netpasr Bmq Unsplash

11/21/2018 - 3 min read

CMS retains $750 “Low Dollar” threshold for 2019

The Centers for Medicare and Medicaid Services (CMS) has released its low dollar recovery threshold for 2019 via an alert dated November 15, 2018. CMS is generally required to publish an annual low dollar threshold amount pursuant to Section 202 of the Strengthening Medicare and Repaying Taxpayers (SMART) Act of 2012.

Jp Valery Lvfoii3sjq8 Unsplash

6/20/2018 - 4 min read

Law firm reaches settlement with U.S. Department of Justice to reimburse Medicare conditional payments and start internal MSP compliance program

The United States Department of Justice (DOJ) for the Eastern District of Pennsylvania has issued a news release reporting that a Philadelphia personal injury law firm has agreed to pay the government $28,000.00 to resolve allegations that the firm failed to reimburse Medicare conditional payments, and agreed to start an internal compliance program to ensure timely repayment of conditional payments going forward.

Court

6/8/2018 - 8 min read

Court denies “double damages” under the MSP’s private cause of action

Currently, there are two questions being litigated that involve who can sue under the Medicare Secondary Payer’s (MSP) private cause of action (PCA) provision and when “double damages” may apply.

Files

5/22/2018 - 5 min read

Arizona tweaks its "full & final" workers' comp settlement law - New law provides opportunities to settle workers' comp claims

Arizona Senate Bill 1100 provides unprecedented opportunities to settle workers' compensation claims in the state.

Michael Longmire Lhltmgdohc8 Unsplash

5/9/2018 - 6 min read

Five steps to reduce your WCMSA costs

It is no secret that high Workers’ Compensation Medicare Set Aside (WCMSA) allocation amounts can complicate claim settlement.

Claims Blind Spots

4/25/2018 - 3 min read

Looking beyond the blind spots to get the whole claims picture

Missing details can be key to settling insurance claims. What insurers don’t know can definitely hurt them.

Hanson Lu Sq5p00l7lxc Unsplash

3/19/2018 - 7 min read

Medicare Advantage update: Connecticut court rules MAPs can pursue “double damages” under the Medicare Secondary Payer statute

Connecticut is the latest jurisdiction to address whether MAPs have private cause of action (PCA) rights to pursue “double damages” under the MSP statute.

Neonbrand Jw6r 0cpyec Unsplash 1

2/12/2018 - 2 min read

Budget Act of 2018 limits Medicaid third-party recovery rights

While most of the headlines focused on the deal’s impact on military expenditures and other issues, the new law also contained an update regarding MSP compliance.

Jeshoots Com Ltnvqhdkkmw Unsplash

1/29/2018 - 7 min read

Now hear this: Medicaid Secondary Payer recovery on the rise

Historically, state Medicaid agencies have been rather flat-footed in making efforts to identify and recoup erroneous payments from non-group health entities. In recent months, however, a number of state Medicaid agencies have more vigorously asserted their recovery rights.

Quino Al 8gweaaxjjti Unsplash

1/19/2018 - 4 min read

CMS holds town hall call on CRC transition - CMS provides important updates on ORM recovery transition

On January 18, 2018, CMS held its Commercial Repayment Center Non-Group Health Plan (NGHP) Town Hall presentation to address the upcoming transition of CRC operations from CGI Federal to Performant Financial Corporation.

Gavel

1/12/2018 - 3 min read

Medicare Advantage Plans update: Illinois court indicates MAPs have “double damages” rights

Whether Medicare Advantage Plans have private cause of action rights to sue claims payers (and others) for “double damages” under the Medicare Secondary Payer (MSP) statute remains a major concern for the claims industry.

Neonbrand Jw6r 0cpyec Unsplash

12/4/2017 - 1 min read

CMS maintains its $750 low dollar threshold for 2018

CMS has announced that it is maintaining the current $750.00 low dollar threshold in 2018 for certain settlement, judgments, awards or other payments.

Bill Oxford R2esy7rxb4m Unsplash

12/1/2017 - 5 min read

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.

Lucas Vasques 9vnacvx2748 Unsplash

11/20/2017 - 4 min read

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’ Compensation Medicare Set-Aside (WCMSA) proposal.

Headway 5qgiuubxkwm Unsplash

11/20/2017 - 3 min read

Mind the gap: Filling the experience void in claims settlements

Today, less than a third of the current insurance workforce is under 35 years old, and it’s predicted that more than a quarter of insurance professionals will be approaching retirement in the next few years.

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