Breaking: CMS Recovery Practice Ruled Improper under the MSP

In an important new case—CIGA v. Burwell, 2017 WL 58821 (C.D. California, January 5, 2017)—the court ruled that the CMS practice of seeking full reimbursement of a medical provider’s single charge—even where some unsegregated portion of that charge relates to services not covered by a workers compensation plan—was improper under the Medicare Secondary Payer Statute […]

A Holiday Present from CMS

Marty Cassavoy

Foreshadowing a major change to Medicare Set-Asides (MSAs), the Centers for Medicare & Medicaid Services (CMS) announced on Wednesday, December 21, that it would unveil new policies in 2017 regarding re-review of MSAs and the use of utilization review in MSAs. The CMS announcement suggests that parties may soon be afforded a second bite of […]

CMS Releases Updated Reporting and Recovery Thresholds with News on TPOCs

Section111TPOC

The Centers for Medicare and Medicaid Services (CMS) has released its latest alert regarding its low-dollar reporting and recovery thresholds pertaining to liability (including self-insurance), workers compensation, and no-fault settlements, judgments, awards, or other payments (settlements). CMS’s December 12, 2016, alert, Change in Reporting Thresholds for Certain Liability Insurance, No-Fault Insurance, and Workers’ Compensation Settlements, […]

Should You Purchase MSA Liability Insurance?

Marty Cassavoy

It’s estimated that the number of Medicare beneficiaries will reach 80 million by 2030. When it comes to Medicare Secondary Payer (MSP) compliance, enforcement will likely increase as the number of beneficiaries grows and Medicare’s budget becomes pinched. Insurers need to start planning now for the increased compliance burdens they may face. So, should you […]

New WCRC contract bid could indicate expansion of MSAs beyond workers compensation

Marty Cassavoy

On September 6, the Centers for Medicare and Medicaid Services (CMS) updated a previously released pre solicitation notice regarding a new contract for the Workers’ Compensation Review Contractor (WCRC). The WCRC reviews and approves Medicare Set-Asides (MSAs) in conjunction with workers compensation settlements. In a prior notice, CMS announced that the new contractor should prepare […]

Removing Impediments to Settlements: Conditional Payments in Liability Claims

Shawn Deane

While the Commercial Repayment Center’s (CRC) conditional payment process has received a lot of coverage in the last eight months, its collections apply only to workers compensation and no-fault claims. It’s important for insurers not to lose sight of their obligations to determine Medicare conditional payments in liability claims, too. While liability conditional payments can […]