312-425-3131
10 South LaSalle Street, Suite 900, Chicago, IL 60603
211 Landmark Drive, Suite C2, Normal, IL 61761
1015 Locust Street, Suite 914, St. Louis, MO 63101
New Opportunities for Amended Review of Medicare Set-Asides
June 2023
On May 15, 2023, the Centers for Medicare & Medicaid Services ("CMS") released Version 3.9 of the Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide. The updated Reference Guide debuts big changes that seem to further the goal of CMS to incentivize the use of their voluntary review and approval process for Medicare Set-Asides.
Most significantly, CMS removed the upper limit for submitting a request for Amended Review of a Medicare Set-Aside. Previously CMS allowed a one-time only request for Amended Review when it had issued a determination on a Medicare Set-Aside Proposal at least 12 months but no more than 72 months prior to submission of the request for Amended Review. In the revised Reference Guide, CMS has removed the 72-month cap. So, there is no longer a date at which a CMS determination becomes “too old” to submit a request for Amended Review.
Update to the Workers’ Compensation Medicare Set-Aside Reference Guide
February 2022
By: Carolyn P. Murray & Surbhi Saraswat Goyal
Key Takeaways:
- 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.
- There is an inherent contradiction in CMS maintaining that the MSA process is voluntary and yet strongly advocating for CMS approval of MSAs.
- 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:
- 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.
- 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.
- The low-dollar review thresholds for liability, no-fault, and workers’ compensation cases remain $750.00 in 2021.
- 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
- 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.
- 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!
- The low-dollar review thresholds for liability, no-fault, and workers’ compensations cases remain $750.00, effective January 1, 2020.
GENERAL TIPS:
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.
| 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 |
| 1015 Locust Street, Suite 914 St. Louis, MO 63101 Phone: 314-300-0527 |
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