PMSI has been informed that the MSPRCMedicare Secondary Payer Recovery Contractor - responsible for verification of conditional payments has completed their review of the RARRights and Responsibilities letter. Issuance of the RARRights and Responsibilities is anticipated to resume on June 10, 2011. A copy of the revised RARRights and Responsibilities will be made available by that time on the MSPRCMedicare Secondary Payer Recovery Contractor - responsible for verification of conditional payments website.
The Demand letter for liability insurance (including self-insurance), no-fault insurance and workers’ compensation still remains under review. The MSPRCMedicare Secondary Payer Recovery Contractor - responsible for verification of conditional payments is still working cases and Demand letters will be mailed out once this review is complete.
It is recommended that clients begin the conditional payment verification process as necessary to get their cases in line for processing. The MSPRCMedicare Secondary Payer Recovery Contractor - responsible for verification of conditional payments has confirmed that once the suspension has been lifted cases will be worked in the order that they were received.
PMSI remains in contact with the MSPRCMedicare Secondary Payer Recovery Contractor - responsible for verification of conditional payments and will continue to monitor this issue. We will advise our clients accordingly as additional information is received.
PMSI has been informed that the MSPRCMedicare Secondary Payer Recovery Contractor - responsible for verification of conditional payments has temporarily suspended the issuance of Rights and Responsibilities (RARRights and Responsibilities) Letters and Demand letters. The following notice has been posted on the MSPRCMedicare Secondary Payer Recovery Contractor - responsible for verification of conditional payments website:
“Issuance of the Rights and Responsibilities (“RARRights and Responsibilities”) and Demand letters has been temporarily suspended while these letters are under review. The MSPRCMedicare Secondary Payer Recovery Contractor - responsible for verification of conditional payments is still working cases, and the RARRights and Responsibilities and Demand letters will be mailed out once appropriate revisions have been made”.
The MSPRCMedicare Secondary Payer Recovery Contractor - responsible for verification of conditional payments has not confirmed how long this suspension of RARRights and Responsibilities and Demand letters will last and has stated that they are still working cases outside of the above noted suspensions. Conditional payment letters (CPLs) will be issued on cases where the RARRights and Responsibilities has already been issued. However, the conditional payment process will be suspended on cases where a RARRights and Responsibilities has not yet been issued as well as those cases where a final Demand has been requested. PMSI will continue our current follow up process for all current pending cases at the MSPRCMedicare Secondary Payer Recovery Contractor - responsible for verification of conditional payments even in light of the current situation.
It is recommended that clients begin the conditional payment verification process as necessary even in light of this announcement to get their cases in line for processing. The MSPRCMedicare Secondary Payer Recovery Contractor - responsible for verification of conditional payments has confirmed that once the suspension has been lifted cases will be worked in the order that they were received.
PMSI remains in contact with the MSPRCMedicare Secondary Payer Recovery Contractor - responsible for verification of conditional payments and will continue to monitor this issue. We will advise our clients accordingly as additional information is received.
CMSCenters for Medicare and Medicaid Services recently issued a Memorandum dated May 11, 2011 confirming there are no statutory or regulatory provisions requiring a WCMSAWorkers' Compensation Medicare Set-Aside be submitted to CMSCenters for Medicare and Medicaid Services for review. Submission of a WCMSAWorkers' Compensation Medicare Set-Aside proposal to CMSCenters for Medicare and Medicaid Services for review and approval is a voluntary process which is recommended by CMSCenters for Medicare and Medicaid Services, but not required. This statement in writing by CMSCenters for Medicare and Medicaid Services should eliminate any confusion in the industry surrounding this issue which is important in light of proposed State workers’ compensation legislation enacting requirements which require submission of WCMSAs to CMSCenters for Medicare and Medicaid Services for review and approval if the CMSCenters for Medicare and Medicaid Services review threshold is met (Maryland).
If the WCMSAWorkers' Compensation Medicare Set-Aside review process is utilized, CMSCenters for Medicare and Medicaid Services requests compliance with their established policies and procedures. The industry is encouraged to regularly monitor the CMSCenters for Medicare and Medicaid Services dedicated workers’ compensation website for changes in policies/procedures.
Below is a summary of the important information in the Memorandum which provides clarification of CMSCenters for Medicare and Medicaid Services’ current policy and procedure regarding review of WCMSAs.
- A WCMSAWorkers' Compensation Medicare Set-Aside should not be submitted to CMSCenters for Medicare and Medicaid Services when the resolution of the workers’ compensation claim results in the medical portion of the claim being left open.
- CMSCenters for Medicare and Medicaid Services will review a WCMSAWorkers' Compensation Medicare Set-Aside when either of the following thresholds are met:
- The claimant is currently a Medicare beneficiary and the total settlement amount is greater than $25,000 .
- The claimant has a “reasonable expectation” of Medicare enrollment within 30 months of the settlement date and the anticipated total settlement amount for future medical expenses and disability/lost wages over the life or duration of the settlement agreement is expected to be greater than $250,000.
- CMSCenters for Medicare and Medicaid Services no longer reviews new WCMSAWorkers' Compensation Medicare Set-Aside proposals if the above thresholds are not met. However, these threshold requirements reflect a CMSCenters for Medicare and Medicaid Services operational workload standard and do not constitute a substantive dollar or “safe harbor” threshold. CMSCenters for Medicare and Medicaid Services confirmed that Medicare beneficiaries still must consider Medicare’s interests in all workers’ compensation cases and ensure that Medicare is the secondary payer.
- Both the beneficiary and non-beneficiary review thresholds noted above are subject to change and CMSCenters for Medicare and Medicaid Services reserves the right to modify or eliminate these thresholds.
Click here to view a copy of the entire Memorandum.
On April 1, 2011, the Florida Bar issued Staff Opinion 30310. The opinion arose out of a dispute between opposing counsels in a personal injury lawsuit. The attorneys specifically sought the Florida Bar’s ethical opinion on whether an attorney, in a personal injury matter, “may personally sign a settlement release containing a hold harmless and indemnification agreement in favor of the opposing party which would obligate the plaintiff’s attorney to indemnify and hold harmless the defendant for any future liability under the Medicare Secondary Payer Act (MSPMedicare Secondary Payer Act).”
Continue reading 'Florida Bar Opinion: Unethical for Plaintiff’s Counsel to Agree to Indemnify the Defendant for Medicare Liabilities'»
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