A Formal Review Program for Liability/No Fault MSAs Is Back

As anticipated, implementation of a formal voluntary Liability Medicare Set-Aside (LMSA) and No-Fault Medicare Set-Aside (NFMSA) review program is at the forefront once again. A proposed rulemaking,  Miscellaneous Medicare Secondary Payer Clarifications and Updates, has been posted by the Office of Management and Budget, which states that A Notice of Proposed Rulemaking (NPRM) will be issued by September 2019.

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Don’t Rely on an MSP Conditional Payment Notice when Executing a Settlement Agreement and General Release

In a recent decision on 3/13/2018, Mayo v. NYU Langone Medical Center, the courts voided a settlement on the grounds of a mutual mistake because both the plaintiff and defense relied upon a conditional payment notice rather than a conditional payment demand or initial determination. The plaintiff provided a conditional payment notice that was dated … Read moreDon’t Rely on an MSP Conditional Payment Notice when Executing a Settlement Agreement and General Release

Important Change Regarding Medicaid Secondary Payer Claim Compliance

On February 9, 2018 President Trump signed into law a new budget deal. The new law also contained an important change regarding Medicaid Secondary Payer compliance. What Optum Had Been Anticipating Optum Settlement Solutions had been anticipating an Oct 1, 2017 effective date for state Medicaid agencies to begin enforcing the Medicaid Secondary Payer Act … Read moreImportant Change Regarding Medicaid Secondary Payer Claim Compliance

CMS Position on Independent Medical Reviews

Prior to the release of the latest Workers’ Compensation Medicare Set Aside (WCMSA) Reference Guide, the Centers for Medicare and Medicaid Services (CMS) would generally defer to the findings of the Independent Medical Review (IMR) and exclude the denied treatment or drugs. However, since the release of the WCMSA Reference Guide, we are seeing CMS … Read moreCMS Position on Independent Medical Reviews

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