Category Archives: MSAs

Medicare Advantage Plans and Workers Compensation Medicare Set-Asides

March 25, 2020 B. Josh Pettingill We are oftentimes asked about injured workers who have a Medicare Advantage Plan (MAP) and if they still need to use their Workers’ Compensation Medicare Set-Aside (WCMSA) funds if the MAP will cover all their medical care. This brief post will explain Medicare’s position on this issue and then…

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Liability Medicare Set-Asides (LMSAs): Insurance Policy for All

March 12, 2020 B. Josh Pettingill This article highlights why a Medicare Set-Aside (MSA) should be viewed by all settlement parties as an insurance policy – nothing more, nothing less. Medicare Secondary Payer Compliance is not a scare tactic, nor is it something to be disregarded. Rather, addressing the MSP by analyzing the need for…

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Liability Medicare Set-Asides (LMSAs): Is It Time to Start Worrying?

B. Josh Pettingill For over a decade, there has been episodic activity from Centers for Medicare and Medicaid Services (CMS) on Liability Medicare Set-Asides (LMSAs), including but not limited to, policy memorandums, Medicare Learning Network announcements, a notice of proposed rulemaking with subsequent withdrawal, an advanced notice of a notice of proposed rulemaking as well…

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WCMSAs and Non-Submit Programs

B. Josh Pettingill Many carriers are moving to “non-submit programs” using Evidence-Based MSAs as the driving force for the change[i]. Getting approval of a Medicare Set-Aside is never required by any law or statute. There are times when not submitting the Workers’ Compensation Medicare Set-Aside (WCMSA) makes sense in order to achieve a resolution. Most…

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The Interplay between Medicare and Medicaid for Injured Workers

Jason D. Lazarus, Esq. This blog post will discuss dual eligibility for injured workers.  It will address exactly what it is and how Medicaid coordinates with Medicare for those that are dual-eligible.  Finally, it will talk about the techniques to preserve Medicaid and Medicare. Some individuals are “dual eligible” meaning they qualify for both Medicaid…

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Injury Victim Gets Part B Denial of Care by Medicare

Jason D. Lazarus, J.D., LL.M., CSSC, MSCC In the past, trial lawyers never had to worry about whether Medicare would pay for their client’s future care post-settlement. There is cause for concern that this may not be the case in the future.  Consider this scenario – you represent a current Medicare beneficiary in a third-party…

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Settlement Language Can Make or Break a Workers Compensation Case

B Josh Pettingill Appropriate settlement language can make a significant impact on the total amount of the workers’ compensation settlement, as well as dollars that the injured worker receives. This brief article will provide plaintiff/applicant attorneys with the requisite settlement language to maximize the workers’ compensation recovery, as well as protect their respective firms and…

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Reversionary Clauses and the Impact on Injured Worker

B. Josh Pettingill Reversionary clauses have become a common term of settlement in workers’ compensation cases involving a Medicare Set Aside (MSA). It is important for workers’ compensation attorneys to understand how these clauses can impact the injured worker, as well as the settlement. What is a reversionary clause? A reversionary clause means that when…

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Evidence Based MSAs (EBMAs): Don’t Accept Blindly

B Josh Pettingill Evidence Based MSAs (EBMSAs) have taken the workers’ compensation industry by storm the past several years. It is imperative for workers’ compensation attorneys to understand how EBMSAs can impact both the settlement value, as well as your clients’ benefits post-resolution. EBMSAs can be a cost savings mechanism in resolving a workers’ compensation…

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Liability Medicare Set-Aside (MSA) Case Studies: Eliminate, Reduce & Comply

B. Josh Pettingill There is mounting evidence that the Centers for Medicare and Medicaid Services (CMS) will establish formal guidelines for liability MSAs in the imminent future.  Medicare Secondary Payor compliance related to future medical care is an issue that can’t be ignored but that doesn’t necessarily mean setting up a Medicare Set-Aside on every…

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