#MSA

CMS Notice of Proposed Rule on Options for Meeting Future Medical Obligations

Melisa Zwilling

Dec 13, 2018

CMS Notice of Proposed Rule on Options for Meeting Future Medical Obligations

In its most recent Regulatory Agenda, the Department of Health and Human Services issued notice of a proposed rule that would provide Medicare beneficiaries and their representatives with options to select for meeting future medical obligations in workers’ compensation, liability, and no-fault cases. The notice does not indicate which options CMS is considering. However, as we previously reported, CMS has stated that it is considering an expansion of the MSA review process

Consideration for Expansion of Medicare Set-Aside (MSA) Arrangements: UPDATE

Melisa Zwilling

Aug 16, 2018

Consideration for Expansion of Medicare Set-Aside (MSA) Arrangements: UPDATE

As we previously reported, CMS has stated that it is considering expansion of the Medicare Set-aside review program to include review of MSAs in liability cases. After a recent meeting with members of the Medicare Set-aside community, it appears that this option is still on the table and could be implemented as soon as Fall 2019. If this expansion is carried out, we expect that CMS will publish a reference guide that will provide specific details on how the liability MSA revi

Medicare Compliance and the Opioid Epidemic - How Policy Changes May Impact Future Treatment

Melisa Zwilling

Aug 16, 2018

Medicare Compliance and the Opioid Epidemic - How Policy Changes May Impact Future Treatment

The opioid epidemic has become the subject of much conversation over the last few years following increases in substance abuse and deaths resulting from the improper use of opioid medications. The Department of Health and Human Services and the Centers for Medicare and Medicaid Services are actively working to combat the epidemic through a number of strategies, some of which could greatly impact the standard of care and appropriate treatment recommendations for certain condi

Consideration for Expansion of Medicare Set-Aside (MSA) Arrangements

Melisa Zwilling

Oct 26, 2017

Consideration for Expansion of Medicare Set-Aside (MSA) Arrangements

As you will recall, on June 11th, 2016 we notified you that CMS issued an alert regarding their intent to consider the review of Medicare Set-asides in both liability and no-fault cases. Earlier today, we received an additional alert confirming that CMS is continuing to consider implementation of a review process in these situations, something we believe further confirms the need to address and protect Medicare’s future interests in liability settlements. As always, we will

CMS Releases New Re-Review Option for WCMSAs

Melisa Zwilling

Jul 19, 2017

CMS Releases New Re-Review Option for WCMSAs

On July 10, 2017, CMS issued an updated Workers’ Compensation Medicare Set-aside Portal (WCMSAP) User Guide which includes an expanded re-review process. The re-review process now allows for an Amended Review of cases where projected care has changed so much that a previously approved MSA amount will change by at least 10% or $10,000 (whichever is greater). The new proposed MSA amount can be greater or less than the previously approved MSA amount as long as the difference is

Workers’ Compensation Appeal Board Enforces Terms of Original Settlement Giving Defendant the Sole O

Melisa Zwilling

Mar 15, 2017

Workers’ Compensation Appeal Board Enforces Terms of Original Settlement Giving Defendant the Sole O

In Scheaffer v. Workers’ Comp. Appeal Bd. Std. Steel, 2017 Pa. Commw. Unpub. LEXIS 103 (February 14, 2017), Mark Scheaffer (Scheaffer) appealed the Order of the Workers’ Compensation Judge (WCJ) approving closure of the medical portion of the case by funding of a Medicare Set-aside. Scheaffer argued that the parties had not reached an agreement to close medical benefits with an MSA and that an order should not have been issued before he had an opportunity to object and provi

Melisa Zwilling

Nov 1, 2016

Fighting For You - CMS Alert

CMS recently indicated that changes had been made to its review of MSA proposals involving denied injuries. These changes could have negatively impacted the amount required for Medicare Set-Asides involving denied injuries and greatly increased the difficulty involved in obtaining CMS approval of MSAs without funds for denied conditions. CMS suggested that either a court ruling, following a hearing on the merits of the claim, addressing the compensability of the injuries or m

New Fee Schedule Set for MSAs in Mississippi

Melisa Zwilling

Sep 13, 2016

New Fee Schedule Set for MSAs in Mississippi

Paragraph XIV of Mississippi’s proposed fee schedule provides that in the event that a claimant settles his or her workers’ compensation claim and the terms of settlement include a Medicare Set-aside (MSA), the fees and charges for reimbursement set forth in the fee schedule shall remain applicable to all treatment and services provided in the exact same manner as if the claim had not been settled. Mississippi’s new fee schedule will take effect November 1, 2016. #Mississippi

Vermont Supreme Court Upholds Finding that MSA Vendor’s Undervaluation of MSA Caused No Economic Har

Melisa Zwilling

Sep 8, 2016

Vermont Supreme Court Upholds Finding that MSA Vendor’s Undervaluation of MSA Caused No Economic Har

In Bindrum v. Am. Home Assur. Co., 2016 Vt. Unpub. LEXIS 150 (Vt. Aug. 19, 2016), the Supreme Court of Vermont recently affirmed the superior court’s granting of summary judgment to Defendant NuQuest Bridge Pointe with respect to Plaintiff’s lawsuit alleging that defendant NuQuest and the workers’ compensation carrier, AIG, undervalued the MSA and unnecessarily delayed sending it to the Vermont Department of Labor for approval. Plaintiff, who was injured in a work-related acc

Carr Allison Scores Major Victories for Clients

Melisa Zwilling

Nov 9, 2015

Carr Allison Scores Major Victories for Clients

With the football season upon us, we’re all rooting for our favorite team to win. It takes a lot of hard work, dedication, determination and skill to win football games. Those things are also required to score victories when it comes to handling Medicare Compliance issues. Our team of attorneys, nurses and paralegals puts in the time and effort to “win” for our clients in every case. Like many underdog football teams, when others say something cannot be done, we say it ca

Search By Tags

Older Posts

Archive: Blog Posts

Archive: Newsletters