Author Archives: nuques

Updated Time Frame for Future Medical Proposed Rule Making

Pursuant to the notification issued on the Office of Information and Regulatory Affairs OMBt website, the proposed rule to address future medicals in liability, no-fault and workers’ compensation cases has been pushed for release to August 2020. The proposed rule entitled Miscellaneous Medicare Secondary Payer Clarification and Updates (CMS-64047) was originally scheduled for release in […]

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CMS and Medicaid to Convert to CDC 2015 Life Table

The Centers for Medicare and Medicaid Services has announced that it will convert to the CDC’s “Table 1: Life Table for the total population: United States, 2015“ for Workers’ Compensation Medicare Set-Aside life expectancy calculations.  The change to the updated life table will become effective as of January 5, 2019.  There is a slight increase […]

nurse explaining to a eldery woman what is on an ipad device

The OMB Issues Intent of Notice of Proposed Rule Making for Section 111 Penalties

In an abstract entitled “Civil Money Penalties and Medicare Secondary Payer Reporting Requirements,” the Office of Management and Budget has issued another intent of Notice of Proposed Rulemaking this time involving Section 111 Reporting penalties.  Specifically, the abstract of the Notice provides as follows: Section 516 of the Medicare Access and CHIP Reauthorization Act of […]

a medical device over hundred dollar bills

Office of Management and Budget Issues Proposed Rulemaking Regarding MSP Compliance Options

Under the title “ Miscellaneous Medicare Secondary Payer Clarifications and Updates,” the Office of Management and Budget issued proposed rulemaking to address Medicare Secondary Payer obligations in the context of automobile and liability insurance, no-fault insurance and workers’ compensation recovery.  The abstract of the proposed rule states as follows: “This proposed rule would ensure that […]

doctor speaking to a patient

Success in the CMS Re-Review Process

Pursuant to Section 16.0 of the Workers’ Compensation Medicare Set Aside (WCMSA) Reference Guide, Version 2.8, October 1, 2018, COBR-Q4-2018-v2.8, CMS will conduct a Re-Review of a prior WCMSA determination in certain circumstances.  Specifically, CMS will complete this process in cases involving a mistake in the allocation; mathematical error; or when there is missing documentation […]

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Settlement reporting threshold of $750 remains for 2019 and Enhancements to the Medicare Secondary Payer Recovery Portal (MSPRP) Coming 1/7/2019.

On 11/15/2018, Medicare issued its annual recovery threshold calculation. This threshold determines the amount of settlement, judgement or award that must be reported to Medicare under the Section 111 reporting rules. For 2019, any settlement, judgement, award at or above $750.00 should be reported to Medicare through Section 111 reporting.  Medicare’s announcement can be found […]

baskets at the basket brigade

2018 Basket Brigade

The Basket Brigade – An Orlando-area holiday tradition that provides food for the holidays to local families in need. In 2017, NuQuest employees donated $2,000 to Led2Serve for the Basket Brigade. This accounted for 103 out of the 1500 baskets delivered by the program.

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Failure to Properly Use the Conditional Payment Administrative Appeal Process

In Mouradian v. United States Government, the United States District Court for the District of Massachusetts found that a Medicare beneficiary did not exhaust the conditional payment administrative appeal process. Because the administrative appeal process was not exhausted, the District Court could not make a decision regarding whether the Medicare Secondary Payer Act (MSP Act) […]

Examining CMS Submission and Appeals

Medicare has established workload review thresholds in determining whether the Medicare Workers’ Compensation Review Contractor (WCRC) will review proposed future medical allocations and provide a recommended Medicare Set-Aside (MSA) amount. If a workers’ compensation settlement involves a Medicare beneficiary and exceeds $25,000.00, the WCRC will review the parties’ settlement and proposed future medical allocation. The […]