New CMS Policy Targets “Evidence-Based” or “Non-Submit” MSAs

Daniel Hayes

The newest version of the “Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide” contains just one change, but this one change was apparently intended to send a strong message to WCMSA industry. According to the new reference guide dated January 10, 2022, CMS is concerned that products commonly called “evidence-based” or “non-submit” MSAs are not…

2022 Medicare Safe Harbor & Reporting Threshold for Liability, No-Fault, and Workers’ Compensation Settlements Remains at $750

Daniel Hayes

As we have addressed previously, under the SMART Act, the Centers for Medicare & Medicaid Services (CMS) is required to set minimum Section 111 mandatory reporting thresholds for liability, no-fault, and workers’ compensation claims.  The reporting threshold also establishes a “safe harbor” regarding the repayment of Medicare conditional payments.  The numbers may fluctuate from year…

The PAID Act is Now Active, Allowing Access to Enrollment Information for Medicare Parts C and D

Daniel Hayes

According to an announcement issued by the Centers for Medicare & Medicaid Services (CMS) on December 13, the Provide Accurate Information Directly (PAID) Act was implemented and became live effective December 11, 2021. Up to this point, when claims were reported to CMS pursuant to Section 111 of the Medicare, Medicaid, and SCHIP Extension Act…

Section 111 Reporting: ORM Termination Dates in North Carolina

Daniel Hayes and Tracey Jones

If a claimant in a workers’ compensation claim is a current Medicare beneficiary, the carrier has certain reporting obligations to the Centers for Medicare and Medicaid Services (CMS).  Under Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), the carrier’s Responsible Reporting Entity (RRE) must not only report any settlement as…

2021 Medicare Safe Harbor & Reporting Threshold for Liability, No-Fault, and Workers’ Compensation Settlements

Daniel Hayes

As we have addressed previously, under the SMART Act, the Centers for Medicare & Medicaid Services (CMS) is required to set minimum Section 111 mandatory reporting thresholds for liability, no-fault, and workers’ compensation claims.  The reporting threshold also establishes a “safe harbor” regarding Medicare conditional payment reimbursements.  The numbers can fluctuate from year to year. …

Daniel Hayes Joins John Cattie for Medicare Set Aside Presentation at SCWCEA Educational Conference

Teague Campbell

Teague Campbell partner Daniel Hayes joined John Cattie for a relevant and timely presentation at the 2018 South Carolina Workers’ Compensation Educational Association’s (SCWCEA) annual conference on Hilton Head Island.  Daniel is a certified MSA consultant and had a book published by the South Carolina Bar addressing Medicare issues in liability and workers’ compensation settlements.…

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

Daniel Hayes

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…