Medicare to Deny Payment for Services Related to MSAs in Liability Settlements

Although there is still no official procedure for submitting Liability Medicare Set-Aside Arrangements (LMSAs) to the Centers for Medicare & Medicaid Services (CMS) for review and approval, CMS announced in a written release to physicians and medical providers/suppliers that, effective October 1, 2017, it intends to deny payment for services under diagnosis codes associated with…

New Medicare Safe Harbor & Reporting Threshold for Workers’ Compensation Settlements

Under the SMART Act, the Centers for Medicare & Medicaid Services (CMS) is required to set minimum Section 111 mandatory reporting thresholds for liability claims, as well as establish a “safe harbor” regarding conditional payment reimbursements.  For liability claims, this number was originally set as $300 as of September 6, 2011, then raised to $1000…

Daniel Hayes Publishes Book on MSAs: Medicare Issues in Liability and Workers’ Compensation Settlements

Medicare Issues in Liability and Workers’ Compensation Settlements by Daniel W. Hayes, J.D., M.S.C.C., was written to guide practitioners through their analysis of how to best consider Medicare’s interests when resolving claims involving medical exposure. The book is presented from the perspective of an insurance defense attorney with over 18 years in practice, who is…

Daniel Hayes & Tracey Jones Present at NAMSAP Regional Meeting

Daniel Hayes and Tracey Jones presented at the NAMSAP Regional Meeting held in Orlando on January 29, 2015.  Their panel discussion, “Protecting the Client,” covered best practices from both the plaintiff and defense perspectives for tackling Medicare Secondary Payer issues in liability and workers’ compensation claims. For information on Daniel and Tracey’s Medicare Set Aside…

Medicare and Liability Settlements: How to Spot Issues and Consider Medicare’s Interests

Introduction When resolving a liability claim involving medical treatment, the parties are required by federal law, pursuant to the Medicare Secondary Payer Act (MSP), 42 U.S.C. 1395y(b)(2), to consider Medicare’s interests with regard to the settlement of the medical portion of the claim.  The intent of the MSP is to prevent settling parties from shifting…