Federal law protects the funding used by Medicare to cover healthcare costs of injured beneficiaries. When another entity - a primary insurance or healthcare plan (the primary payor, or PP) - has a legal obligation to cover those costs, the Medicare Secondary Payor Act (MSP) authorizes Medicare to obtain reimbursement from that PP entity of [...]
In almost all Workers’ Compensation (WC) cases, the Medicare Set-Aside account (MSA) includes a certain percentage of funding to cover the pharmaceutical expenses that are involved in many recovery protocols. MSAs related to more significant injuries such as loss of limbs or temporary or permanent disabilities often reserve the highest financial value specifically for drugs [...]
The Centers for Medicare and Medicaid Services (CMS) may be allowing an exception to the federal rule that asserts no state law will supersede its jurisdiction under any circumstances. An updated Reference Guide for Worker's Compensation Medicare Set-Aside Arrangements (WCMSA) version 2.6, suggests that CMS may be more willing than before to let state law [...]
Since October 2015, the recovery of Medicare health care payments from both Group (GHP) and Non-Group Health Providers (NGHP) has been managed by CGI Federal. CGI is the first contractor for the Centers for Medicare and Medicaid Services (CMS) Commercial Repayment Center (CRC), which collects back from third-party entities provisional payments made by Medicare on [...]
On October 1, 2017, the Centers for Medicare and Medicaid Services (CMS) was scheduled to stop paying for health care services that should, instead, be covered by parties deemed responsible for those damages pursuant to liability and no-fault insurance cases. In early 2017, the agency had announced that Medicare-beneficiary claimants in both liability and no-fault [...]
America is struggling to contain its nation-wide opioid epidemic, which has taken thousands of lives and crippled the lives of many thousands more. In mid-2016, President Obama signed the Comprehensive Addiction and Recovery Act (CARA), the first federal law designed to provide a comprehensive, balanced, and coordinated strategy to improve access to and treatment for [...]
There is a new Worker's Compensation Recovery Center WCRC contractor in place as of September 1, 2017. The new contractor is Capital Bridge LLC, headquartered in Arlington VA., which replaces Provider Resources Inc. (PRI). The contract award is notable for several reasons: It comes two months later than its announced date. Since early July, all [...]
Opioid Treatment Offers Hope to Injured Workers Despite increased press coverage and a growing sense of national alarm, America's opioid addiction problem continues to expand. The number of people dying of overdoses each year has skyrocketed so high that it is impacting the calculations that determine the average American lifespan. And tragically, in the majority [...]
For the first time, parties involved in a Workers' Compensation Medicare Set-Aside (WCMSA) can request a re-review of the MSA value when they dispute the CMS determination or when the financial circumstances of medical care vary from the approved MSA amount by ten percent or $10,000. In the past, insurers, corporations, and injured persons had [...]
Last month, CompEx MSA National Division LLC (CompEx MSA) received notice that the State of Florida has certified it as a Minority-Owned Florida Certified Business Enterprise. The certification secures our position as a valued vendor of Medicare Set-Aside services within the state and the country and celebrates the fact that our Hispanic American heritage expands [...]
