Lien
SCOTUS Limits Medicaid Lien Recoveries
On March 20, 2013 the Supreme Court released its decision in Wos v. EMA, a federal case determining the legality of North Carolina’s Medicaid recovery statute. The Court held that the anti-lien provision of the federal Medicaid Act prevents a state from taking any portion of a judgment or settlement not designated as medical care. […]
House & Senate Pass Medicare’s SMART Act
Both the House and Senate passed the SMART act prior to the Christmas holiday last week. In the House just 3 “no” votes were cast against 401 “yes” votes. The Senate passed the act without a single “no” vote. There is little doubt that President Obama will sign the bill into law. What is the […]
Medicare Advantage Plans Entitled to Medicare Liens
In late June, the 3rd Circuit held that Medicare Advantage Plans (“MAP” or “MAPs”) have the same rights to reimbursement as regular Medicare. The district court in In Re Avandia Marketing, 2011 U.S. Dist. LEXIS 63544, (E.D. Penn. 2012) originally held the plans do not have the same rights to reimbursement as regular Medicare. However, […]
LRS Public Comment: CMS-6047-ANPRM – CMS Proposed Rules for Liability Medicare Set-Asides
As you should know, Medicare has taken its first steps toward requiring Medicare Set-Asides in all personal injury cases. On June 15, 2012, it (via CMS and HHS) posted a request for public comment on rules it hastily created for a potential LMSA system. Our initial analysis of the federal register posting from June 15 […]
Medicare Case Type Definitions: Liability & No-Fault
The most important part of Medicare lien resolution occurs months (or even years) before you send payment to the MSPRC. That most important process is reporting to the Coordination of Benefits Contractor (“COBC”). If you report the wrong date of incident you risk wasting months of work. If you report the wrong injuries you risk […]
Medicare Conditional Payment Notices
Yesterday I saw more Conditional Payment Notices from Medicare in one day, than I had the entire month of April. Conditional Payment Notices (“CPNs”) are different than Conditional Payment Letters (“CPLs”), but they should not concern you if you know how to respond. This post will discuss what is a CPN, what do to with […]
Liability MSA (LMSA) Cases Cited by the MSA Industry
Many of those involved in the MSA industry (including CMS officials) point to “LMSAs” being approved by Federal District Courts. These cases are circulated on listservs and message boards as reminders that LMSAs may be necessary in certain cases. These cases all carry one extra piece of information worth noting: the underlying injuries were the […]
MSPRC to Introduce Web Portal in Summer 2012
The MSPRC has announced it will release a web portal for conditional payments much like that used for Workers’ Compensation MSAs. From the MSPRC release: Coming Soon – The Medicare Secondary Payer Recovery Portal A new online Self-Service Tool to help manage your Medicare recovery case. The Centers for Medicare & Medicaid Services (CMS) is […]
The Congressional Failure to Understand Medicare
Congressman Dennis Ross (Republican – Lakeland, Fl) spoke to the National Association of Medicare Set Aside Professionals (“NAMSAP”) convention on Friday, March 30, 2012. Congressman Ross’s topics were Medicare liens and Medicare Set-Asides. Note: I started this post as a recap of Congressman Ross’ talk with NAMSAP – but it turned into an 1111 word rant […]
Louisiana District Court on LMSAs
On Tuesday, March 13, 2012, the Western District of Louisiana heard arguments regarding a potential Liability Medicare Set-Aside (“LMSA”). The argument was brought to the court on the “Motion for Determination of Need for, and the Amount of Medicare Set Aside.” While the court heard testimony from Plaintiff Warren Frank’s treating physician and his pharmacist, […]
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