Tag Archives: CMS

Post-Settlement Conditional Payment Issues in Workers’ Compensation Claims

May 13, 2021 Rasa Fumagalli JD, MSCC, CMSP-F The conditional payment recovery process in a workers’ compensation claim is not always smooth. Although the workers’ compensation insurance carrier will generally resolve any conditional payments in an accepted claim, the injured employee and counsel may find themselves in receipt of a post-settlement conditional payment notice or…

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Beware of Problematic Medicare Secondary Payer Compliance Settlement Terms

April 15, 2021 Rasa Fumagalli JD, MSCC, CMSP-F Medicare Secondary Payer (MSP) compliance settlement terms utilized by defendants are often overly broad in nature. The recent opinion, Kupolati v. Village of Timber Creek Association, 2021 N.J. Super. Unpub. LEXIS 7 (App. Div. Jan. 5, 2021) and Abate v. Wal-Mart Stores, No. 1:17-cv-288-SPB, 2020 WL 7027481…

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Medicare Secondary Payer Compliance Challenges in WC Cases

March 11, 2021 Rasa Fumagalli JD, MSCC, CMSP-F Medicare Secondary Payer compliance issues in workers’ compensation cases are generally straightforward when the parties seek review of the Workers’ Compensation Medicare Set-Aside (WCMSA) proposal and proposed settlement by the Centers for Medicare and Medicaid Services (CMS). Oftentimes the employer/carrier will elect to fund the CMS-approved WCMSA…

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CMS Continues Push to Reduce Improper Payments Under the Medicare Program

December 10, 2020 Rasa Fumagalli, JD, MSCC, CMSP-F The Centers for Medicare & Medicaid Services (CMS) recently issued a press release announcing a steady decline in improper payments under the Medicare Fee-For-Service program over the past few years. The improper payment rate decreased to 6.27% in the fiscal year 2020, down from 7.25% in the…

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Liability Medicare Set-Asides: Where are we Today?

November 12, 2020 By: Rasa Fumagalli, JD, MSCC, CMSP-F The Centers for Medicare and Medicaid Services (CMS) has been slow in providing detailed guidance in the area of liability settlements that include compensation for future medicals. To date, the guidance consists of the May 2011 CMS Stalcup memo and the September 2011 CMS memo regarding…

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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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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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