New Mexico Federal District Court Finds CMS’ Failure to Clarify if MSAs are Required in Liability Settlements Proving Burdensome in Settlement Process

Posted by Rafael Gonzalez on Dec 22, 2017 1:00:00 PM

On November 28, 2017, the United States District Court for the District of New Mexico published its opinion in Silva v. Burwell, concluding that the uncertainty created by CMS's repeated failure to clarify its position on requiring MSAs in personal injury settlements generally and in specific cases is proving burdensome to the settlement process. The Court further finds this case is not ripe for review because no federal law mandates CMS to decide whether Plaintiff is required to create a MSA. The Court reiterates that just because CMS has not responded to Plaintiff's requests to clarify whether an MSA is required in personal injury claims is not reason enough for this Court to step in and determine the propriety of its actions. There may be a day when CMS requires the creation of MSA's in personal injury cases, but that day has not arrived.

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Topics: CMS

Florida Federal District Court Finds MAPs Must Abide by Same Laws and Regulations Imposed on Medicare When Seeking Reimbursement

Posted by Rafael Gonzalez on Nov 15, 2017 9:37:34 AM

On September 20, 2017, the United States District Court for the Southern District of Florida published its opinion on MSPA Claim I, LLC., v. National Fire Insurance Company of Hartford, finding that since it is undisputed that on June 4, 2014, at the time of the settlement in this case, the threshold amount referenced in paragraph (9) of the Medicare Secondary Payer Act (MSP) was set at $2,000, and that National Fire's settlement was for $1,500, the threshold to bring an MSP private cause of action is not met. The Court therefore concludes that Plaintiff does not state a cognizable claim under the MSP. Having found the threshold amount is not met, the Court did not reach the standing issue as to whether the Plaintiff had a valid assignment at the time it filed suit.

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Topics: CMS, Compliance, Medicare Law

Social Security Number Removal Initiative (SSNRI) now known as “New Medicare Cards”

Posted by Gina Cox on Jul 28, 2017 8:00:00 AM

The Centers for Medicare & Medicaid Services (CMS) announced this week that the Social Security Number Removal Initiative (SSNRI) will now be known as “New Medicare cards.” Regardless of what the program is called, the bottom line is that the old Social Security Number based Health Insurance Claim Number (HICN) will be replaced by a new Medicare Beneficiary Identifier (MBI). This is not exactly new news as the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 required CMS to remove Social Security Numbers from all Medicare cards by April 2019 and CMS announced the upcoming transition earlier year.

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Topics: CMS, Compliance, Claims Processing

Finally, a Re-Review Process for Work Comp Medicare Set Asides, But Still No Formal Appeals Rights for Claimants and Employer/Carriers

Posted by Rafael Gonzalez on Jul 18, 2017 3:31:11 PM

The Centers for Medicare & Medicaid Services (CMS) has put together a mechanism to receive and evaluate future medical and future prescription drug costs for inclusion in Workers’ Compensation Medicare Set-Aside Arrangements (WCMSAs). The Workers’ Compensation Medicare Set-Aside Portal (WCMSAP) is a web-based application that allows attorneys, beneficiaries, claimants, insurance carriers, representative payees, and WCMSA vendors to create a work-in-progress case, submit WCMSA cases, perform case lookups, append documentation to a case, receive alerts relating to case activity, and now submit a re-review request.

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Topics: CMS, Medicare Law

The Medicare Secondary Payer Program Continues to Grow in Size and Scope as CMS Adds to its Matrix of Compliance Enforcement Contractors

Posted by Rafael Gonzalez on Jun 7, 2017 8:00:00 AM

By now, everyone involved with auto, liability, no-fault, and workers compensation claims is aware that the Medicare Secondary Payer Act (42 U.S.C. 1395y) was passed by Congress and signed into law by President Jimmy Carter in December 1980. However, the current Medicare Secondary Payer (MSP) compliance program we are all familiar with today didn’t really get started until the mid 1990’s, traced back to HIPPA’s Medicare Integrity Program.

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Topics: CMS

Yet Another Clue that CMS is Getting Ready for Liability and No-Fault MSAs

Posted by Rafael Gonzalez on Mar 10, 2017 9:00:00 AM

As I blogged about in CMS Prepares for Expansion of MSA Reviews, Postpones Release of Solicitation for Contractor and P&C Insurers, Are You Ready for Mandatory Reporting, Conditional Payments, and Set Aside AllocationsCMS has been hinting about liability and no-fault set asides for a while. In February of 2017, they dropped another clue that they are getting ready for liability and no-fault Medicare set-asides.

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Topics: CMS, Liability, MSA

CMS Updates Mandatory Reporting User Guide, Providing New TPOC Timelines and Amounts on No-Fault, Liability, Work Comp Claims

Posted by Rafael Gonzalez on Jan 10, 2017 10:19:23 AM

On January 3, 2017, the Centers for Medicare and Medicaid Services (CMS) published Version 5.2 of the Section 111 NGHP User Guide. The Mandatory Insurer Reporting (MIR) updates listed below have been made to Chapter III, Policy Guidance.

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Topics: CMS

Could 2017 be the Year CMS Finally Begins WCMSA Appeals Process?

Posted by Rafael Gonzalez on Dec 22, 2016 4:06:33 PM

On December 21, 2016, the Centers for Medicare & Medicaid Services (CMS) published an announcement indicating it “recently revisited the task of reviewing its process for addressing requests for CMS to “re-review” otherwise approved Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) amounts.” As a result of its re-visitation on this issue, CMS announced that “in calendar year 2017, CMS expects to update its existing re-review process to address situations where CMS has provided an approved amount, but settlement has not occurred and the medical care that supported the approved amount has changed substantially.”

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Topics: CMS, medicare compliance

CMS Announces New Reporting Thresholds for 2017

Posted by Brian Cox on Nov 16, 2016 9:27:42 AM

The Centers for Medicare & Medicaid Services (CMS) announced the reporting thresholds for Liability, No Fault and Workers Compensation claims for 2017. Section 1862(b) of The SMART Act requires CMS to review its costs related to recovering conditional payments compared to recovery amounts annually.

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Topics: CMS, medicare compliance

How to Avoid Overpaying Medicare

Posted by Kendell Gracey on Mar 24, 2015 6:00:00 AM

As a Responsible Reporting Entity (RRE), it's not an option to inaccurately or incompletely report Medicare-related settlement claims under Section 111 requirements. It also doesn’t make sense to report them properly, then fail to submit payment to Medicare. In both cases, the penalties are too steep to justify any sort of negligence.

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Topics: CMS, Compliance, paid costs