CMS Issues Notice of Proposed Rulemaking Regarding an Appeals Process to be utilized by Applicable Plans for Conditional Payment Disputes

On December 27, 2013, CMS issued a NPRM relating to circumstances where “applicable plans” (liability insurance, no-fault insurance, and workers’ compensation law or plans) can appeal recoveries which are sought by Medicare under the MSP directly against applicable plans. Organizations or individuals seeking to have commentary considered should provide their recommendations via one of the … Read moreCMS Issues Notice of Proposed Rulemaking Regarding an Appeals Process to be utilized by Applicable Plans for Conditional Payment Disputes

Haro v. Sebelius Reversed (in part): Medicare May Seek Upfront Reimbursement of Conditional Payments Despite Pending Appeals/Waivers

Some of us in the industry may remember an interesting case back from May of 2011 where a class of Medicare beneficiaries successfully obtained an injunction against CMS for certain conditional payment reimbursement practices. The two conditional payment practices that Haro sought to enjoin were: 1) requiring pre-payment of an MSP reimbursement claim before the … Read moreHaro v. Sebelius Reversed (in part): Medicare May Seek Upfront Reimbursement of Conditional Payments Despite Pending Appeals/Waivers

Fifth Circuit Affirms: Medicare Cannot Recover Conditional Payments where Treatment is Unauthorized under State Law

We previously blogged about a case wherein Medicare was unable to recover conditional payments due to the fact that the claimant sought unauthorized treatment under Texas workers’ compensation law. Please click here to read our prior blog. On appeal, the Firth Circuit has affirmed this decision; please see Caldera v. The Insurance Company of the … Read moreFifth Circuit Affirms: Medicare Cannot Recover Conditional Payments where Treatment is Unauthorized under State Law

Reminder: PMSI to Host CE Accredited Webinar

Next week, Heather Schwartz, Esq., MSCC, CHPE, CLMP, CMSP will offer her expertise in reference to the SMART Act and other MSP legal updates on Tuesday, April 16, 2013 from 1 PM -2 PM EDT. The webinar is complimentary and 1 hour of CEU and CLE credit has been applied for in multiple states; all … Read moreReminder: PMSI to Host CE Accredited Webinar

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