Settlement News

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 […]

Simplifying MSA Account Administration with BP’s MSP Card

CMS has issued specific guidelines that address the proper administration of a Medicare Set Aside (MSA) account. The guidelines require that the MSA funds only be used for injury-related Medicare-covered treatment and Medicare-covered pharmacy expenses. Certain costs such as document copying charges, mailing fees/postage, banking fees related to the account and income tax on interest […]

Join Us on November 7th – Highlights of WCMSA Reference Guide Updates

Rasa Fumagalli, JD, MSCC Join us on November 7th, 2017 at 1:00 CST Register here for a webinar that discusses the changes that were made to the updated WCMSA Reference Guide (Version 2.6, July 10, 2017). We will look at the new Amended Review process as well as the expanded state specific Statute section. CMS’ […]

WCRC’s Application of Updates to the WCMSA Reference Guide

Nancy Heidrich, BSN, RN, CDMS, MSCC With the release of the WCMSA Reference Guide, Version 2.6 dated July 10, 2017; how is the WCRC actually applying these guidelines when reviewing a WCMSA? CMS noted 13 changes to Version 2.6 of the Guide. Three of these changes are addressed below. The expanded state specific statute guidelines […]

Escaping CMS’ “Haunted” Submission Maze

Rasa Fumagalli, JD, MSCC Under the Medicare Secondary Payer Act, Medicare is not allowed to make payment where payment has been made or can reasonably be expected to be made under a workers’ compensation law or plan, automobile or liability insurance policy or plan. 42 U.S.C. 1395 y(b)(2 (A)(ii). A Medicare Set-Aside (“MSA”) allocation is […]

NuQuest’s Spine Tingling Result with the New Amended Review Process

Rasa Fumagalli, JD, MSCC CMS announced the new Amended Review process in the July 2017 updated WCMSAP guide and in the updated WCMSA Reference Guide. Within days of the releases, NuQuest submitted an amended review seeking a significant reduction in CMS 2014 WCMSA determination of $2.3 million. As expected, the amount of the CMS determination […]

JoinUs on July 10th! Proper Administration Webinar

Join us on July 10th, 2017 at 1:00 (CST) Register here for a webinar that addresses the proper administration of an MSA. We will review CMS’ specific guidelines on this issue and address common mistakes that may be made in self-administration. We will also go over tools that may assist in the administration process. Rasa […]

Dispelling MSP Compliance Misconceptions

“Fake News”, “alternative facts” and rumors have been in the forefront of the news cycle over the past year. The discussions all highlight the need to scrutinize the source of the information that is being shared and assess its credibility. Although Medicare Secondary Payer compliance issues may not be as exciting as some of the […]

Simplifying MSA Account Administration with BP’s MSP Card

CMS has issued specific guidelines that address the proper administration of a Medicare Set Aside (MSA) account. The guidelines require that the MSA funds only be used for injury-related Medicare-covered treatment and Medicare-covered pharmacy expenses. Certain costs such as document copying charges, mailing fees/postage, banking fees related to the account and income tax on interest […]

Join Us on January 31st! Medicare Advantage Webinar

Join us on January 31st, 2017 at 1:30 (CST) Register here for a webinar that will recap some of the noteworthy MSP Private Cause of Action claims brought by Medicare Advantage Plans in 2016. We will also discuss best practices for addressing payments made by Medicare Advantage Plans when handling or settling your claims. Rasa […]