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211 Landmark Drive, Suite C2, Normal, IL 61761

211 North Broadway, Suite 2200, St. Louis, MO 63102

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Update to the Workers’ Compensation Medicare Set-Aside Reference Guide

February 2022

By: Carolyn P. Murray & Surbhi Saraswat Goyal

Key Takeaways:

  1. The Centers for Medicare and Medicaid Services (CMS) has updated its Workers’ Compensation Medicare Set-Aside (WCMSA) Reference Guide to directly address the insurance industry's frequent use of Evidence Based MSA and Non-Submit MSA.
  2. There is an inherent contradiction in CMS maintaining that the MSA process is voluntary and yet strongly advocating for CMS approval of MSAs.
  3. CMS’s implementation of this new change remains to be seen.

On January 10, 2022, CMS issued an updated WCMSA Reference Guide, Version 3.5. The updated WCMSA Reference Guide only included one change; however, it is causing a ripple throughout the Medicare industry.

Section 4.3: The Use of Non-CMS-Approved Products to Address Future Medical Care now states as follows:

21 More Medicare Tips For 2021

June 2021

In 2020, the Brady, Connolly & Masuda, P.C. Medicare Compliance Department (MCD) provided our top 20 tips and updates for the Medicare Secondary Payer world (https://conta.cc/2T6NjH4). Since then, we have all overcome new obstacles, developed innovative processes, and continued to advance the practice. With 2021 in full swing, the MCD presents 21 more tips and updates for you.

GENERAL INFORMATION:

  1. Start. Early! The MCD continues to emphasize early investigation into possible Medicare implications for your claims in order to avoid delay in resolution down the road.
  2. With that said…it is never too late. Whether the claimant is still treating, you have settled the claim, or the permanency portion of the claim has been closed for some time, the MCD can always offer recommendations to resolve possible Medicare-related issues throughout your claims.
  3. The low-dollar review thresholds for liability, no-fault, and workers’ compensation cases remain $750.00 in 2021.
  4. Rated ages are not only useful for future medical analyses, but can also decrease potential exposure for other aspects of claims. Please reach out to us if you need assistance with obtaining a rated age.

Two Heads Are Better Than One

June 2021

By: Markeya A. Fowler and Carolyn P. Murray, MSCC

Two heads are better than one! We have all heard this old adage and found it to be true more often than not. Brady, Connolly & Masuda, P.C. is proud to share one such case where two practice groups came together to achieve a great result.

One of the hardest to contain and costliest parts of any workers’ compensation case is the exposure for future medical. That task becomes even more arduous when the claimant is a Medicare recipient. Our attorneys, Markeya Fowler (Workers’ Compensation Litigator) and Carolyn Murray (Certified Medicare Consultant) were faced with this task in a work injury claim. Together, they formulated and implemented a strategy which completely mitigated the future medical exposure for the client.

The claimant alleged that he was involved in two accidents occurring a month apart. He claimed an injury to his shoulder on June 11, 2012 while removing baseboards and to his bilateral hands on July 12, 2012 while prying out tile. As the case developed, we were able to identify evidence that called into the question the claimant’s credibility, as well as the alleged mechanism of injury.

20 Medicare Tips for 2020

January 2020

By: Marina Takagi Cobb, MSCC, CMSP

    GENERAL TIPS:

  1. Start early! When preparing an initial analysis of a workers’ compensation claim, keep note of: claimant’s date of birth, Social Security Disability status, and Medicare entitlement date, in order to initiate a Medicare investigation early.

  2. The BCM Medicare Compliance Department is available to assist with any Medicare-related issues throughout the pendency of a claim. Please do not hesitate to contact us at any time during your case. It is never too early or too late!

  3. The low-dollar review thresholds for liability, no-fault, and workers’ compensations cases remain $750.00, effective January 1, 2020.

Medical Investigation & Argument Wins Over CMS

January 2019

By: Marina Takagi Cobb

The Firm was defending a Comp case brought by a petitioner who initially asserted an injury to his foot. While diagnostic imaging of the right foot and ankle showed no fractures, petitioner continued to complain to his orthopedic surgeon of not only right foot pain but, also, right knee discomfort. He asserted he had to “twist(ed) the leg” in the accident. The surgeon diagnosed a right foot crush injury, a right foot contusion, and a right knee sprain/strain, for which the petitioner underwent conservative treatment. Within a month of the alleged incident, the orthopedic surgeon noting the petitioner was exaggerating symptoms and complaints, released him from treatment, and sent him back to full duty.

The petitioner then sought a second opinion from another orthopedic physician. This time, the petitioner alleged right hip pain that was exacerbated by the work incident. The petitioner also complained of shoulder pain and low back pain.

Medicare "Liens": Departure From The Past Continues With Medicare Advantage Plans and Private Causes of Action

June 2018

When Medicare was created in 1965, the original legislation made Medicare "secondary" to workers' compensation (WC), and Medicare was not supposed to pay for any expenses that were covered under a WC claim. In 1980, Congress expanded this idea into the area of liability and no-fault cases. For years, insurers, attorneys, and parties to litigation could simply contact Medicare and negotiate a resolution of any medical bills paid by Medicare that were related to a particular claim. In the past decade or so, Medicare has ramped up its efforts to collect "conditional payments," so-named because Medicare pays the bills on condition that the "primary" insurance will later reimburse Medicare. The Centers for Medicare and Medicaid Services (CMS) has set up two different contractors to handle conditional payments: the Benefits Coordination & Recovery Center (BCRC) and the Commercial Repayment Center (CRC), and different procedures apply to each contractor, including differentiating the party or parties with whom Medicare will even communicate. Failure to pay back conditional payments can subject a primary plan to double damages, interest, and litigation costs. As labyrinthine as this system may already seem, any liable party or insurer needs to beware that the BCRC and CRC only handle "traditional" Medicare, which includes Medicare Part A (hospitalization) and Part B (medical) coverage where Medicare has made payments directly to the health care providers.

  • Chicago Bar Association
  • Workers' Compensation Lawyers Association
  • IRTB
  • DRI - The Voice of the Defense Bar
  • The Illinois Association of Defense Trial Counsel
  • Illinois Self-Insurers' Association
  • Chicago Bar Association
  • Workers' Compensation Lawyers Association
  • IRTB
  • DRI - The Voice of the Defense Bar
  • The Illinois Association of Defense Trial Counsel
  • Illinois Self-Insurers' Association
10 South LaSalle Street, Suite 900
Chicago, IL 60603
Phone: 312-425-3131
211 Landmark Drive, Suite C2
Normal, IL 61761
Phone: 309-862-4914
One Metropolitan Square
211 North Broadway, Suite 2200
St. Louis, MO 63102
Phone: 314-300-0527
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