CMS Awards New WCRC Contract

Over the past year CMS has been seeking a new and qualified vendor to take on the role of the WCRC through a Request for Proposal (RFP) process. On June 16, 2011, CMS awarded Provider Resources Inc. with the WCRC contract. The award notice posted by CMS on June 23, 2011 outlines the primary responsibilities … Read moreCMS Awards New WCRC Contract

Common Issues in MIR Reporting

The reporting required by CMS to fulfill Mandatory Insurer Reporting (MIR) requirements went live on January 1, 2011. The processes to achieve full compliance are complex and require extensive technology, data scrubbing and timely submission for entities that must report claims. Many reporting entities have encountered difficulties, including significant issues with data validation—resulting in either not reporting eligible claims or unnecessarily reporting ineligible claims to CMS. These data issues can increase risk for payers, as data reported with errors can result in temporary suspension of reporting with CMS, increasing the risk of non-compliance penalties. Following is a sample of some of the challenges RREs face in meeting compliance and the potential results of these issues.

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Haro v. Sebelius – Medicare Conditional Payment Collection

Haro v. Sebelius- Medicare Conditional Payment CollectionIn Haro v. Sebelius, putative class Plaintiffs, Medicare beneficiaries and an attorney representing the beneficiaries challenged the CMS program for reimbursement of Medicare conditional payments under the MSP and were rewarded for their efforts with a win against CMS in Arizona District Court. In times when CMS is broadly and according to some commentators, exceeding its authority when attempting to enforce the provisions of the Medicare Secondary Payer Act (MSP), it is refreshing to find an example of CMS being challenged. [1]

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Superior Court of New Jersey Allows Plaintiff Attorney’s Fees to be Deducted from MSA Allocation

There has been a great deal of commentary from the liability industry concerning the necessity of liability Medicare Set-Aside (MSA) allocations under the Medicare Secondary Payer Act (MSP), and whether the published guidance applicable for workers’ compensation MSAs  provides any insight regarding how liability MSAs should be handled. Although there is no statutory requirement to create an MSA when future medical expenses are awarded, it is recommended by the Centers for Medicare and Medicaid Services (CMS) and has become a best practice in workers’ compensation cases. In liability cases, resistance to MSAs continues due to a lack of published guidance and issues that are specific to liability cases. For example, if a settlement is only $100,000, and the projected MSA is $150,000, how can plaintiff’s attorneys get their fees if the entire settlement is taken up by an MSA?

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