Cases & Points Blog

Join us on 4/4 – WCMSA Reference Guide Webinar

Join us on Thursday, April 4th at 2:00 PM (EST) with Bridget Smith and Jennifer Shymanski for a comprehensive analysis of the new WCMSA Reference Guide Version 2.9. We will review the various additions and changes to the new Guide and the potential impact these may have on WCMSAs.  Register here!

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Medicare Advantage Organization Recovery Rights

In published opinion filed on March 18, 2019, the United States Court of Appeals for the 11th Circuit affirmed the district court’s dismissal of MSPA Claims 1, LLC (MSPA) for failure  to sue a “primary plan” pursuant the private cause of action provisions in the Medicare Secondary Payer Act (MSP Act). In MSPA Claims1, LLC […]

CMS Hosts MSPRP Electronic Payment Enhancement Webinar

The March 13, 2019 webinar offered by CMS provided a description of the new direct payment features available through the Medicare Secondary Payer Recovery Portal (MSPRP) as of April 1, 2019.  CMS will be releasing presentation slides within five (5) to seven (7) days and will also be releasing the audio recording thereafter.  Some of […]

CMS Announces Webinars for MSPRP and CRCP Electronic Payment Options

CMS will be hosting two webinars to review the addition of a new electronic payment option that will be added to the Medicare Secondary Recovery Portal (MSPRP) and the Commercial Repayment Portal (CRCP) effective April 1, 2019.  The webinars will include opening remarks followed by a presentation on the new electronic payment functionality. The MSPRP […]

Conditional Payments in Review: 2018

In February of 2018, we saw a new contractor operating Medicare’s Commercial Repayment Center (CRC), Performant Financial Corporation.  As expected, there were growing pains or learning curves experienced with the new operator, such as: inappropriate referrals to U.S. Treasury for collection, letters of authorization inappropriately denied, statement of reimbursement forms not matching decision letters and […]

Confusion, Conjecture and Clarification: The New WCMSA Reference Guide

With the issuance of updated Workers’ Compensation Medicare Set-Aside Reference Guide version 2.9 (Guide), there has some speculation and even confusion as to what is really new and what is an elaboration of old policies and procedures.  Examples listed for off-label drug usage to new bullets added regarding the submission process, all of which begs […]

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CMS Issues a Revised WCMSA Reference Guide and Section 111 User Guide

The Centers for Medicare and Medicaid Services issued a revised WCMSA Reference Guide (Reference Guide), Version 2.9, which can be found here: WCMSA Reference Guide.  In addition to changes to development and alert templates; references to removal of certain memorandum from cms.gov; and reference to the updated CDC Life Table, the Reference Guide also includes updates […]

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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 […]

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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 […]

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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 […]