LexisNexis® Legal Newsroom
Medicare - New User Guide and Alerts - Considerations

I have a lot to share with you about the newly released User Guide and recent alerts from CMS. Before I start, I would be remiss; if I didn't first thank Jim Price from Aon San Francisco for his thoughtful read of my draft and time he has spent with me discussing the possible ramifications of these...

New CMS Life Expectancy Table Effective July 19, 2010

Lansing, MI (CompNewsNetwork) - The Centers for Disease Control (CDC) has published its 2006 United States Life Tables. Effective July 19, 2010, the Centers for Medicare & Medicaid Services (CMS) will begin referencing the CDC's Table 1: Life table for the total population: United States, 2006...

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...

“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...

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...

Workers’ Compensation and Its Secondary Payers: Medicare and Medicaid

Last November I had the pleasure of participating in a panel with two more eminently qualified folks—Jennifer C. Jordan of MEDVAL, LLC and Tim Nay at Nay & Friedenberg —about Medicare Secondary Payer (MSP) compliance at the 23rd Annual National Workers’ Compensation and Disability...