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…
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…
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…
Before a proposal for a Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) may be voluntarily submitted to the Centers for Medicare & Medicaid Services (CMS) for formal review, the claimant must provide written permission to the submitter by completing a Consent to Release form. In the past, there have been situations where a claimant may have…
Co-authored by Shannon Till Poteat, Member, Robinson Gray Stepp & Laffitte, LLC 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…
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…
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. …
As workers’ compensation professionals, we are all too familiar with Medicare Set Asides (MSAs) in settlements. But are we required to include a fully-funded MSA in a compromise settlement? According to the Centers for Medicare & Medicaid Services (CMS), the answer is no. CMS Approval of Zero-Dollar Allocation We know that CMS will issue Zero…
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.…
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…