On July 31, 2017, CMS published Version 2.6 of the Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide. The latest version of the Guide includes the following changes:
With 73 million beneficiaries as of December 2016, Medicaid has become our country’s largest healthcare insurance program. With more beneficiaries in every age group, the likelihood of such beneficiaries becoming involved in an auto, liability, no-fault, or work comp claim has also grown exponentially. When this happens, just as with Medicare, Medicaid becomes a secondary payer. The corporate defendant, its insurer, or the beneficiary and his/her attorney, if the claim settles, becomes responsible for any payments related to such claims, including reimbursement of any expenditures made by the state Medicaid agency or the insurer/managed care organization that may have contracted with the state to provide such Medicaid benefits.
Topics: medicare compliance
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.”
In 2017, new thresholds will be applied to the Section 111 reporting requirements for liability, no fault, and worker’s compensation claims. In a nutshell, here are the changes you need to be aware of:
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.
If your goal is 100% Medicare Compliance, then Reporting and Recovery need to go hand in hand as the Dynamic Duo of your claims process.
Flagship Services Group is one of the country’s premiere Medicare Secondary Payer (MSP) compliance services providers. It focuses on the property and casualty insurance industry, meaning its clientele are auto, no-fault, medical malpractice, products liability, general liability and workers compensation insurers. As a result, Flagship speaks to case adjusters, claims supervisors, regional managers, and insurance executives from around the country on a daily basis. More and more, these conversations are about Mandatory Insurer Reporting (MIR). And very specifically, more and more of these conversations are about correctly reporting Ongoing Responsibility for Medicals (ORM), and Total Payment Obligation to Claimant (TPOC).
Without much fanfare or a lot of attention, on September 20, 2016, Congressman Tim Murphy (R-PA) and Congressman Ron Kind (D-WI), the same members of Congress who were responsible for passage of the SMART Act and its troubled aftermath, introduced HR 6120 to amend title XVIII of the Social Security Act with the intended purpose of “providing for clarification and rationalization of Medicare prescription drug plan recovery rules for certain claims.” Several provisions of the proposed bill would help workers compensation, auto, no-fault, and liability primary payers diminish their responsibility for Medicare Part D prescriptions under the Medicare Secondary Payer Act (MSP).
2015 was another banner year for property and casualty insurers, writing close to $600 billion worth of insurance. Is this growth and success the reason for the Centers for Medicare and Medicaid Services' (CMS) recent announcement on June 8, 2016, in which CMS indicated it is considering expanding its voluntary Medicare Set Aside (MSA) review process to include the review of proposed liability insurance (including self-insurance) and no-fault insurance MSA amounts? Or are there other reasons for such an attempt by CMS at this time?
As the No-Fault and Workers Compensation process with the Commercial Repayment Center (CRC) continues to unfold, many P&C Carriers are now receiving the next round of automated notifications from Medicare regarding outstanding conditional payments. For many, this is the first time they have seen an Intent to Refer letter.