Reporting
SMART Act: Is Medicare Lien Resolution Smarter Now?
On January 10, 2013, President Obama signed H.R. 1845. Included on the Medicare IVIG Access Bill is the SMART Act. SMART was designed to reform the conditional payment, final demand, and MMSEA Section 111 reporting processes. Click here to read the full text of H.R. 1845. As you can see below, we aren’t as excited […]
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, […]
Federal Register – June 15, 2012: Advanced Notice of Proposed Rulemaking (LMSAs)
The Friday, June 15, 2012 Federal Register includes a four-page request for public comment requested by the Department of Health and Human Services’ Centers for Medicare & Medicaid Services. The comment is requested for potential changes to 42 CFR Parts 405 and 411 and is titled, “Medicare Program; Medicare Secondary Payer and ‘Future Medicals.’ “ […]
Misconceptions: It’s Not a Valid “Lien” Unless They Put Me on Notice
The most troubling “liens” are the ones that come up unexpected. But why do liens come up without warning? For starters, we have to remind you that we all use the term lien loosely. Most of the time we are not dealing with liens at all. The usual encumbrance is either a subrogation right, a […]
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 […]
Update: New Medicare RRE Reporting Guidelines
On September 30, 2011 the Centers for Medicare and Medicaid Services (“CMS”) revised its Mandatory Insurer Reporting timelines – again. The difference between this change and the previous revisions and moratoriums is that certain cases must be reported. Which cases? Funny you should ask: The only cases that must be reported are those with total […]
Medicare & No-Fault: Speed Up the Process
If you practice personal injury, especially automobile accident law, you will run into extra steps for Medicare liens. Medicare has long required information regarding any kind of No-Fault insurance before it compiles a Final Demand for your case’s lien. Even if you’re not in a No-Fault insurance state you need to keep reading. Why? As […]
The MSPRC’s New Use of Conditional Payment Notices
Medicare’s MSPRC began sending Conditional Payment Notices (“CPNs”) last year. At that time, MSPRC representatives explained the use CPN in Town Hall Meetings. That use has seemingly changed. What is a CPN? It is notice given by the MSPRC that: It is aware you have settled; It may not know the settlement amount, fees, and […]
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