Future Interests (MSAs)

Now Available – CMS Electronic Payment Enhancement Overview

CMS has now posted the Electronic Payment Enhancement Overview Webinar presentations which were held on March 13, 2019, for NGHP and March 14, 2019, for GHP.  The presentations can be found in the Downloads section of the Coordination of Benefits & Recovery Overview What’s New page on CMS.gov.

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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 […]

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 […]

a medical device over hundred dollar bills

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 […]

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 […]

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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 […]

Construction Claims and Medicare Secondary Payer Compliance – Construction Claims Fall Edition 2018

Construction claims present unique and complicated Medicare Secondary Payer statute (“MSP”) issues. Often such claims involve multiple defendants – each of whom may have different levels of involvement and responsibility for underlying claims. Each claim may follow a different timeline, with some claims settling early and others lingering for years. Not to mention that each […]