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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...

California WCMSA Case: Did Clinical Need for Medical Treatment Occur Faster Than CMS Process for Approving Medicare Set-Aside?

By Jennifer C. Jordan, Esq. In California, there is a unique trend compared to the rest of the nation in that the Medicare Set-Aside process is primarily defense driven with less than full disclosure to the Applicants. While not applicable to all employers/insurers, it is problem enough that the Applicant's...

California WCMSA Case: Did Clinical Need for Medical Treatment Occur Faster Than CMS Process for Approving Medicare Set-Aside?

By Jennifer C. Jordan, Esq. In California, there is a unique trend compared to the rest of the nation in that the Medicare Set-Aside process is primarily defense driven with less than full disclosure to the Applicants. While not applicable to all employers/insurers, it is problem enough that the Applicant's...

Recent Medicare Set-Aside Changes

By Jennifer C. Jordan, Esq., General Counsel, MEDVAL, LLC Liability Medicare Set Asides Of the series of memos released by CMS on September 30, 2011, the most notable established a policy for when a liability Medicare set-aside (LMSA) would not be required [ see http://www.cms.gov/COBGeneralInformation...

Recent Medicare Set-Aside Changes

By Jennifer C. Jordan, Esq., General Counsel, MEDVAL, LLC Liability Medicare Set Asides Of the series of memos released by CMS on September 30, 2011, the most notable established a policy for when a liability Medicare set-aside (LMSA) would not be required [ see http://www.cms.gov/COBGeneralInformation...

Illinois Court Permits Ex-Wife to Take a Percentage of MSA Account as Part of Divorce Action

By: Mark Popolizio, Esquire, Crowe Paradis Services Corporation In the case of In re Marriage of Washkowiak , 2012 Ill. App. Lexis 151 (Ill. App. 3 Dist., March 7, 2012) the Illinois Appellate Court ruled that a claimant’s former wife was entitled to receive 17.5% of the funds from his Medicare...

CMS Releases Advance Notice of Proposed Rulemaking in "Future Medical" Situations

By: Marty Cassavoy & Mark Popolizio, Crowe Paradis Services Corporation On May 3, 2012, the Centers for Medicare & Medicaid Services (CMS) provided early notice that it would be publishing proposed rules regarding Medicare Secondary Payer (MSP) compliance obligations in relation to “future...

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...

National and State-by-State Workers' Comp News Roundup Powered by Larson's (7/16/2012)

Sign up here for our free workers' compensation enewsletters (National or California Edition) to receive weekly news items. Be sure to select the enewsletter of your choice. NATIONAL: NCCI: Claim Frequency Declined One Percent in 2011 . Forbes: Steve Schmutz Interview of Impact of Obamacare...

Love It or Hate It: Medicare Secondary Payer Enforcement Is Here to Stay

By Jennifer C. Jordan, Esq. Progress is the theme of this year’s update to The Complete Guide to Medicare Secondary Payer Compliance , 2012 Edition (available in October; see special offer below). Nothing has improved so much that people don’t still cringe at the mention of MSAs, but after...

Delaware IAB Enforces MSA Commutation Where Surgery Is Proposed After the Fact...and a Cupcake

Today's post is a pretty dry discussion by Sassy Cassy standards. I stumbled across a recent Motion Day ruling that presents a potentially novel issue and has a little something to offer on the topic of enforceability of settlements. That and the whole spectrum of issues presented by commuting medicals...

Delaware IAB Enforces MSA Commutation Where Surgery Is Proposed After the Fact...and a Cupcake

Today's post is a pretty dry discussion by Sassy Cassy standards. I stumbled across a recent Motion Day ruling that presents a potentially novel issue and has a little something to offer on the topic of enforceability of settlements. That and the whole spectrum of issues presented by commuting medicals...

National and State-by-State Workers' Comp News Roundup Powered by Larson's (9/4/2012)

Sign up here for our free workers' compensation enewsletters (National or California Edition) to receive weekly news items. Be sure to select the enewsletter of your choice. NATIONAL NEWS: CMS Announces Coverage Change Re TENS Units Included With WCMSA Proposals . SSA Issues New Rules on...

Medicare Secondary Payer: Conditional Payment Reimbursement Policies for Certain Liability Settlements

By Jennifer C. Jordan, Esq., General Counsel, MEDVAL, LLC In an effort to resolve Congressional concerns about the cost of MSP recovery efforts compared to the recoveries themselves, CMS started creating policies in the fall of 2011 to reduce the agency’s involvement in low dollar liability settlements...

California WCMSA: Separate Settlements for Each Claim - The Benson Case

By Robert G. Rassp, Esq. Appellate review of California Labor Code Sections 4663 and 4664 on apportionment has mandated that physicians provide in their conclusions with reasonable medical probability approximately what percentage of permanent disability or impairment is directly caused by each industrial...

California WCMSA: Separate Settlements for Each Claim - The Benson Case

By Robert G. Rassp, Esq. Appellate review of California Labor Code Sections 4663 and 4664 on apportionment has mandated that physicians provide in their conclusions with reasonable medical probability approximately what percentage of permanent disability or impairment is directly caused by each industrial...

National and State-by-State Workers' Comp News Roundup Powered by Larson's (2/25/2013)

Sign up here for our free workers' compensation enewsletters (National or California Edition) to receive weekly news items. Be sure to select the enewsletter of your choice. NATIONAL NEWS: IAIABC Responds to Inappropriate Opioid Use Critical to Workers Compensation . CMS Clarifies Re-Evaluation...

Medicare Secondary Payer: The Shape of Things to Come

By Jennifer C. Jordan, Esq., General Counsel, MEDVAL, LLC 2013 is shaping up to be a big year for MSP change. The question is whether that change will be good or bad. Last summer we were hopeful the new WCRC contractor would bring about positive change on the WCMSA front, but after several months...

National and State-by-State Workers' Comp News Roundup Powered by Larson's (4/8/2013)

Sign up here for our free workers' compensation enewsletters (National or California Edition) to receive weekly news items. Be sure to select the enewsletter of your choice. NATIONAL NEWS: Judges Rule AIG/Liberty Mutual Settlement Won’t Adversely Affect Pending Appeal. AIG Reduced...

National and State-by-State Workers' Comp News Roundup Powered by Larson's (4/15/2013)

Sign up here for our free workers' compensation enewsletters (National or California Edition) to receive weekly news items. Be sure to select the enewsletter of your choice. NATIONAL NEWS: Group Calls for State-Run SSI System With Parallel Features of State WC System . NCCI’s 2013...

National and State-by-State Workers' Comp News Roundup Powered by Larson's (5/13/2013)

Sign up here for our free workers' compensation enewsletters (National or California Edition) to receive weekly news items. Be sure to select the enewsletter of your choice. NATIONAL NEWS: Columnist Warns About Loss of State Regulated Workers’ Comp BWC Staffer Defends Ohio BWC Workers...

NCCI Research Brief on Medicare Set-Asides and Workers' Compensation

NCCI has recently examined the demographics related to MSAs (distributions of amounts of MSAs and total settlements that include MSAs; distributions of ages of claimants) and the aspects of the CMS review process (length of time from submission to CMS approval; relation between submitted and CMS-approved...

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...

CMS Unveils New Details About “Amended Review” Process

By Jennifer C. Jordan, Esq. Since the very beginning of its MSP enforcement efforts around the turn of the century, CMS has avoided the regulatory process and developed MSP related policies and practices informally. By doing this, CMS has been able to make changes whenever it sees fit without being...