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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...

Opioids – The Grand Debate

An examination of ACOEM’s newly revised opioid practice guidelines for treatment of pain By Robert G. Rassp, Esq. We hate statistics but policymakers can’t live without them. For example, 100 million residents of the United States have chronic pain according to a 2011 report from...

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...

California Official Medical Fee Schedule: The Death of the Extraordinary Circumstances Exception Post-2004

In what appears to be a case of first impression, the WCAB panel in Jaime Torres Tavera v. T and P Farms, Zenith Insurance Company , 2015 Cal. Wrk. Comp. P.D. LEXIS --, reversed the WCJ’s finding and held instead that the extraordinary circumstances exception to the fee schedule applies only to...

Medical Expert Says U.S. Health Industry Often Guilty of “Overkill”

Significant percentage of medical care procedures is unnecessary Much has been written about the explosion of health care costs in the workers’ compensation system. Indeed, most experts agree that medical care expenses now represent more than 60 cents out of every benefit dollar provided to...

Settlement Not Binding When CMS Never Approved Medicare Set-Aside: Cal. Comp. Cases October Advanced Postings (9/24/2015)

Here’s the latest batch of advanced postings for the October 2015 issue of Cal. Comp. Cases. Lexis.com and Lexis Advance subscribers can link to the case to read the complete headnotes and summaries. © Copyright 2015 LexisNexis. All rights reserved. Calvin Collins, Petitioner v...

Pennsylvania: Claimant Retires and Moves to Nevada, but Court Says No Evidence She Withdrew From Workforce

A Pennsylvania appellate court held that it was error to suspend a claimant’s benefits solely because she received a disability pension and had moved to Nevada for its warmer climate; there was no evidence that she had permanently removed herself from the workforce. The claimant indicated her body...

An Alarming Mortality and Morbidity Trend Among Middle-Aged White Non-Hispanic Americans Suggests Implications for Ability to Work

Despite strides in medical care, mortality/morbidity is rising among this important demographic due to drugs, alcohol, suicide, liver disease and cirrhosis According to a study recently released by two Princeton University economists, the broadly observed long-term decline in mortality rates among...

Here’s Why You Shouldn’t Miss the WCRI 32nd Annual Conference

Anyone familiar with the Workers Compensation Research Institute’s 32-year history of providing the data and analysis that industry mavericks rely upon to understand, manage and effect real change have come to expect WCRI conferences to provide the discussion and debate of cutting edge issues and...

California Workers’ Comp Case Roundup (4/29/2016)

CALIFORNIA COMPENSATION CASES Vol. 81 No. 4 April 2016 A Report of En Banc and Significant Panel Decisions of the WCAB and Selected Court Opinions of Related Interest, With a Digest of WCAB Decisions Denied Judicial Review CONTENTS OF THIS ISSUE © Copyright 2016 LexisNexis. All rights...