Medicare Set-Asides and Medicare Compliance

A Second Bite at the WCMSA Apple?

The Centers for Medicare & Medicaid Services (CMS) Removes Maximum Time Limit to use Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Amended Review Process By Shannon Metcalf Do you have cases that you cannot settle due to an outdated, CMS-approved WCMSA?  If so, there is good news as CMS has changed the Amended Review process to […]

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Medicare Aims to Shut Down Non-CMS-Approved WCMSAs

The Centers for Medicare and Medicaid Services (CMS) issued an updated Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide – Version 3.5, on January 10, 2022. In that Reference Guide, CMS reiterated that submitting a WCMSA proposal for review is never required, but is recommended, as the WCMSA review process is “the only process that […]

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Medicare Provides New Way to Terminate Ongoing Responsibility for Medicals (ORM)

The Centers for Medicare and Medicaid Services (CMS) issued an updated Section 111 NGHP User Guide – Version 6.4, on June 11, 2021. CMS will now allow the termination of ORM if the following criteria are met. Where there is no practical likelihood of associated future medical treatment, which is reflected by meeting ALL of the following: […]

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Centers for Medicare and Medicaid Services (CMS) Maintains $750 Reporting Threshold

The SMART Act requires CMS to annually review the costs associated with the collection of Medicare conditional payments and set forth a threshold amount applicable to settlements, judgments, awards, or other payments (TPOC amount) for which it will not seek recovery. The threshold amount for 2020 was $750.00. On November 25, 2020, CMS announced the […]

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Medicare Liens: Another Concern Prior to Settlement?

In our last post, we discussed the issues posed by ERISA liens and how the presence of an ERISA lien can complicate a potential settlement. Another similar issue that complicates settlements is the potential presence of a Medicare lien. This applies to workers’ compensation and liability cases. The Medicare Secondary Payer Act (MSPA), 42 U.S.C. […]

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