2011 Alphabet Soup: MSA, CMS, WCMSA, MSPRC, COBC, C&R, RRE, ORM, TPOC, EIEIO - The Latest in Medicare, Social Security and Your Large C&R in California

By Robert G. Rassp, Esq. Yes, so, the last one is a joke – Old MacDonald had a farm… We have recently traveled all over the country talking about and listening to the effect CMS has had on all of the stakeholders in the entire workers’ compensation community and not just in California...

MO: Settlement Contract Put Asunder No ‘Thriller’ For Comp Employers

Settle a case, write a check, and most employers believe a worker's compensation case is over. It's not so easy, sometimes. Some claimants come back, like zombies in a b-movie thriller, haunting employers once again fighting over just what a settlement means. Say what you mean. How bad...

Vermont Moves Towards Single-Payer Healthcare, Will New Jersey Be Next?

Last month, Vermont laid the groundwork for the establishment of a universal single-payer healthcare system in that state. Now a similar plan is being supported by a group called the New Jersey One Plan One Nation. This group states that universal healthcare is an issue of human rights and supports the...

“Off Label” Uses of Medical Products and Services

By Vernon Sumwalt, Esq. Under most workers’ compensation programs, coverage for medical treatment differs from the coverage afforded by other plans. For example, state workers’ compensation programs often cover “reasonable and necessary” medical expenses related to an injury...

Delay in Calculating a Structured MSA Can Cost You, It’s Free, So Why Wait?

By Teddy Snyder, Esq. I got the call again. I’m in California, but this case closure scenario can happen anywhere. “I have a signed C&R for $46,000 with CMS approval. Can you save me some money?” The answer is “Probably, but it will be more complicated, because you waited...

MSP Compliance and the Late, Great Jerry Garcia

This year marks the 10th anniversary of the Patel Memo , the memo that launched the Medicare Secondary Payer industry. We are forced to look back over the past decade and recognize just how far we have come. As the late, great Jerry Garcia would say, “What a long strange trip it’s been”...

MSP Compliance and the Late, Great Jerry Garcia

This year marks the 10th anniversary of the Patel Memo , the memo that launched the Medicare Secondary Payer industry. We are forced to look back over the past decade and recognize just how far we have come. As the late, great Jerry Garcia would say, “What a long strange trip it’s been”...

Medicare, Medicaid, and SCHIP Extension Act (MMSEA) Section 111 Reporting: Identifying Reporting Triggers – 2011 Updates

It is important to be familiar with the criteria for reporting to avoid being late in adhering to the MMSEA Section 111 requirements. The determination of whether to submit a claim is dictated by two criteria, both of which must be met to require reporting: 1. The claimant is Medicare-entitled; and...

Medicare, Medicaid, and SCHIP Extension Act (MMSEA) Section 111 Reporting: Identifying Reporting Triggers – 2011 Updates

It is important to be familiar with the criteria for reporting to avoid being late in adhering to the MMSEA Section 111 requirements. The determination of whether to submit a claim is dictated by two criteria, both of which must be met to require reporting: 1. The claimant is Medicare-entitled; and...

CMS Announces New "Self-Calculated Final Conditional Payment Amount" Option for Certain Liability Claims

By Mark Popolizio, Esquire Section 111 Senior Legal Counsel Crowe Paradis Services Corporation The Centers for Medicare and Medicaid Services (CMS) will implement a new Self-Calculated Final Conditional Payment Amount option beginning in February 2012 through which Medicare’s “final”...

CMS Announces New "Self-Calculated Final Conditional Payment Amount" Option for Certain Liability Claims

By Mark Popolizio, Esquire Section 111 Senior Legal Counsel Crowe Paradis Services Corporation The Centers for Medicare and Medicaid Services (CMS) will implement a new Self-Calculated Final Conditional Payment Amount option beginning in February 2012 through which Medicare’s “final”...

Court Grants Hearing in LHWCA Settlement When CMS Declined to Review Case Within Its Thresholds

By Jennifer C. Jordan, Esq., General Counsel, MEDVAL, LLC Medicare set-asides have become an albatross for all insurers. And despite all their efforts to do exactly what CMS wants in the interest of protecting the Medicare Trust funds, CMS is constantly changing the rules or arbitrarily making random...

Four Reasons to Avoid the CMS Approval Process for MSAs

By Teddy Snyder, Esq., Ringler Associates - Beverly Hills, CA 1. MMSEA reporting makes approval unnecessary for Medicare beneficiaries. Reporting under the Medicare, Medicaid and S-Chip Extension Act, aka “section 111 reporting”, started January 1, 2010 for workers compensation claims...

Four Reasons to Avoid the CMS Approval Process for MSAs

By Teddy Snyder, Esq., Ringler Associates - Beverly Hills, CA 1. MMSEA reporting makes approval unnecessary for Medicare beneficiaries. Reporting under the Medicare, Medicaid and S-Chip Extension Act, aka “section 111 reporting”, started January 1, 2010 for workers compensation claims...

Court Dismisses Suit Seeking to Hold Carrier Liable for Reimbursing Medicare Payments

By: Mark Popolizio, Esquire In Caldera v. Insurance Company of State of Pennsylvania , No. C-11-321, 2012 U.S. Dist. LEXIS 12888 (S.D. Texas February 2, 2012) a claimant filed a private cause of action claim against the workers’ compensation carrier seeking double damages under the Medicare Secondary...

Workers Comp and the Affordable Healthcare Act

Assuming that Obamacare isn't grievously wounded by Congressional de-funding and that a Romney win in the election doesn't result in repeal of the law, what effect will it have on workers' comp? I've already received several client e-mails asking whether the Affordable Healthcare Act...

Workers Comp and the Affordable Healthcare Act

Assuming that Obamacare isn't grievously wounded by Congressional de-funding and that a Romney win in the election doesn't result in repeal of the law, what effect will it have on workers' comp? I've already received several client e-mails asking whether the Affordable Healthcare Act...

The WCMSA Conundrum in California

By Robert G. Rassp, Esq. The following email string is true, accurate and correct. It is a typical email string between an applicant’s attorney and a defense attorney. We all have cases like this in our inventories. In this case, the Applicant was a medical laboratory technologist who sustained...

The WCMSA Conundrum in California

By Robert G. Rassp, Esq. The following email string is true, accurate and correct. It is a typical email string between an applicant’s attorney and a defense attorney. We all have cases like this in our inventories. In this case, the Applicant was a medical laboratory technologist who sustained...

Cost-Shifting of Workers’ Compensation Expenses: Study Says Third Parties Pick Up Most of the Bill

By John Stahl, Esq. A study that J. Paul Leigh, Ph.D. , and James P. Marcin, MD, MPH conducted addressed cost shifting that occurred when the workers’ compensation system did not absorb the entire cost of a compensable incident. They reported their findings in an article entitled “Workers’...

California: Can an Attorney Fee Be Requested on a Medicare Set-Aside Trust?

Lexis.com subscribers can link to the cites below. As any participant in the workers’ compensation system over the past ten to fifteen years can tell you, if you want to discuss a Compromise and Release, you will likely also have to consider “Medicare’s interests” in evaluating...

CWCI Finds Use of Compounded Drugs in California Workers’ Comp Are Down, But Payments Are Up

New CWCI research shows that compounded drugs accounted for a declining share of California workers’ compensation prescriptions last year following reforms intended to contain the use and associated costs of these drugs and changes in how they are billed, but despite this decline, compound drug...

CWCI Finds Use of Compounded Drugs in California Workers’ Comp Are Down, But Payments Are Up

New CWCI research shows that compounded drugs accounted for a declining share of California workers’ compensation prescriptions last year following reforms intended to contain the use and associated costs of these drugs and changes in how they are billed, but despite this decline, compound drug...

Ambulatory Surgery Centers: Rapid Growth and Lack of Oversight in California

By John Stahl, Esq. Concern regarding the relatively little public information about heavily utilized ambulatory surgery centers (ASCs) in California prompted the California HealthCare Foundation (Foundation) to research ownership statistics and other data regarding these facilities that service rapidly...

Thank Heaven for Little Girls….. and “Clean Claims” in Delaware

This comes to us from Christopher Logullo of Chrissinger & Baumberger, also known as in-house counsel for Liberty Mutual. I had commented recently about how I love hearing from counsel regarding their cases and more importantly, their take on the Board’s ruling and for a second time this week...