CMS recently released the results of its ‘Computation of Annual Recovery Thresholds for Certain Liability Insurance, No-Fault Insurance, and Workers’ Compensation Settlements, Judgments, Awards, or Other Payments.’ According to the report from the CMS Financial Services Group, the average cost of collection for Non-Group Health Plan (NGHP) cases (liability insurance and self-insurance, no-fault insurance, and workers’ compensation) is $297 per case. This calculation was base

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

In January 2017, we posted an article concerning a recent case, Cali. Ins. Guar. Ass’n v. Burwell, No. 2:15-cv-01113-ODW (FFMx), 2017 U.S. Dist. Ct. LEXIS 1681. As you may recall, the Defendant (CMS) paid medical benefits on the behalf of three individuals who were also covered under workers’ compensations policies administered by the Plaintiff (California Insurance Guaranty Association (CIGA)). CMS sought reimbursement from CIGA for the payments issued and CIGA argued that t

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On June 18, 2015, CMS issued an Alert entitled "Modification of Matching Criteria Used When Reporting Partial Social Security Numbers for Liability Insurance (Including Self-Insurance), No Fault Insurance, and Workers’ Compensation." The text of that alert is copied below: New Matching Criteria for Partial SSNs In order to determine if individuals are Medicare beneficiaries, the following information is used: •HICN or SSN •First initial of the first name •First 6 characters