Here We Go Again, as New Medicare Contractor Takes Over Reimbursement of Conditional Payments When ORM Accepted

Posted by Rafael Gonzalez on Feb 1, 2018 10:06:51 AM

Rafael Gonzalez, Esq., President, Flagship Services Group


After 35 years of seeking reimbursement of conditional payments post settlement, judgment, award, or payment of a case, in 2015, the Centers for Medicare & Medicaid Services (CMS) transitioned a portion of the Non-Group Health Plan (NGHP) Medicare Secondary Payer (MSP) recovery workload from the Benefits Coordination & Recovery Center (BCRC) to its Commercial Repayment Center (CRC). As a result, on October 5, 2015, the CRC assumed responsibility for the recovery of conditional payments where CMS is pursuing recovery directly from a liability insurer (including a self-insured entity), no-fault insurer or workers’ compensation entity, referred to as Applicable Plans (AP), as the identified debtor. Since then, CMS, through a contract with CGI, had been pursuing recovery directly from APs as the identified debtor when an applicable plan reports that it has ongoing responsibility for medicals (ORM) or otherwise notifies CMS of its primary payment responsibility.

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Topics: MSA, Medicare Law, Conditional Payments

A Complete Comparative Analysis of the Changes in the New Workers Compensation Medicare Set-Aside Arrangement Reference Guide

Posted by Rafael Gonzalez on Aug 4, 2017 4:17:19 PM

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:

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Topics: medicare compliance, MSA, Medicare Law

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

P&C Insurers, Are You Ready for Mandatory Reporting, Conditional Payments, and Set Aside Allocations in Auto, No-Fault, and Liability Claims?

Posted by Rafael Gonzalez on Sep 30, 2016 11:13:22 AM

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?

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Topics: Liability, medicare compliance, MSA, Medicare Law

Medicare Compliance: Do I Need an MSA?

Posted by Brian Cox on Jul 7, 2016 10:30:00 AM

We recognize your confusion. Claims adjusters, lawyers, and claimants themselves have a hard time understanding whether or not they need (or should get) a Medicare Set-aside Arrangement (MSA). We often hear that understanding MSAs can be a challenge because of varying opinions on compliance and admittedly, vague Medicare laws on the subject.

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Topics: MSA

Demanding More From Your WCMSA Provider to Ensure Medicare Compliance

Posted by Brian Cox on Jul 5, 2016 9:59:11 AM

Many companies write, evaluate, and offer services for Workers’ Compensation Medicare Set-Aside Arrangements (WCMSAs). Do these companies take into consideration your unique claim circumstances, your company’s risk tolerance and your overall claims management strategy?

Let’s start with a brief overview of the typical WCMSA process and the key details to consider as you choose a Medicare compliance partner.

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Topics: Compliance, medicare compliance, MSA

5 Common Myths of Medicare Set-Asides

Posted by Brian Cox on Mar 17, 2016 9:17:15 AM

Common Medicare Set-Aside (MSA) myths or mistakes persistently come up despite the best efforts of attorneys, consultants, financial professionals, and a Medicare compliance service provider, like Flagship Services Group, to squash them.

P&C insurance companies that routinely process worker’s compensation and liability claims, and even the individual claims examiners and claims managers who are responsible for overseeing the claim and settlement process, are losing money, time, and becoming increasingly frustrated with a process that should be fairly straightforward.

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Topics: medicare compliance, MSA

Components Of A Flagship WCMSA

Posted by Rafael Gonzalez on Mar 8, 2016 8:47:00 AM

The Flagship Difference

Flagship Services Group partners with you to provide an MSA that fits each unique claim and strategy.

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Topics: Compliance, MSA