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CMS WCMSA Against CIGA Turned Away By Federal Court

CMS WCMSA Medicare A CMS WCMSA is turned away by the Federal Court system partially.  Acronyms are as follows : CMS – Center for Medicare Medicaid Services WCMSA – Workers Compensation Medicare Set  Aside CIGA – California Insurance Guarantee Association The order can be found here..   It is a

Is Social Security Disability Affected by WC?

Social Security Disability Does Workers Compensation have an effect on Social Security Disability?  More precisely, do Social Security Disability applications increase when WC payments decrease? This was pointed out in the Work Comp Analysis group on LinkedIn today.  In reading over the study, I was at first very skeptical. The

59 Modifier Medical Bill Controversy Causes CMS To React

59 Modifier Medical Bill Confounds CMS The 59 Modifier Medical Bill Controversy.A friend of mine forwarded a note on how medical bills could have be over-inflated by the use of what is known as a 59 modifier.  Her company does not use that modifier. According to Optum – a medical

How Long Would Workers Compensation Survive Like This???

Could Workers Compensation Survive With High Overpayments? Today, I was wondering how long would Workers Compensation survive when examining the following situation. The process of Workers Compensation is going to always involve claim over-payments. Any time that I hear “We have X, Y & Z process in place to not overpay

CMS Self Administered Toolkit for WCMSA’s – Confusing Section

CMS Self Administered Toolkit This article is a continuation of  the CMS Self Administered Toolkit.  The CMS (see yesterday’s J&L Blog article) has done a good job in attempting to provide injured employees with a guide if they decide to self-administer their WCMSA’s (Workers Compensation Medical Set Asides).   Most

NCCI – Massive New Study On Long Term Claims

Massive New Study On Long Term Claims NCCI has recently published what I would refer to as a very hybrid study of the long term medical costs on Workers Comp claims.  Claims data is usually examined by NCCI, the WCIRB (CA Rating Bureau), and other rating bureaus with a corresponding

Medicare Set Aside Enforcement Caused Claim Counts To Spiral

Medicare Set Aside Enforcement Caused a Backlog? Did the Medicare Set Aside Enforcement by CMS cause claims count to spiral?   The Medicare Set Asides (MSA’s) for Workers Comp article that I posted on last week is here. I wanted to continue that article. After a few intense calculations, I

Premium Audit For Large Deductible Programs

Large Deductible Programs I had been asked this question three times over the last two weeks. “We have a large deductible programs for our Workers Comp.” Can those policies be audited for overcharges?” The three main questions that I asked were: Did your company pay some type of premium to your

Medicare Set Asides Cause Claim Counts To Spiral?

Medicare Set Aside Claim Counts I was reading a few articles this week on the rise of Workers Comp claim counts. I was astonished at the number of open Workers Compensation claims. Are some TPA’s, employers and insurance carriers deciding to leave their clams open for a longer period of

Liability CLaims MSA Reporting Now Due To CMS

Liability Claims MSA Report Now Required By CMS The Liability Claims MSA reports are now due. The data for Workers Comp Medicare Set Asides (WCMSA or MSA) were supposed to be reported to the CMS by January 1, 2010 by insurance carriers, TPA’s or employers. There was a little confusion

Medicare Set Aside Compliance Rules Directly From CMS

Medicare Set Aside Compliance Rules -A History and Analysis The Medicare Set Aside compliance rules begin with the MSA Memo from CMS. I have been asked numerous times over the last few months on the status of the Workers Comp Medicare Set asides. Many questions centered around what type of

Upcoming MSA Crisis Or Should I Say Past?

The Upcoming MSA Crisis Is an MSA crisis upcoming? I am not a Medicare Set Aside Agreement (MSA) expert. There are few people that actually are overall. The one concern I have is that I do not think all participants are compliant with the reporting requirements by the MSA. The

Medicare Set Aside (MSA) Rules – In Nutshell

Medicare Set Aside (MSA) Rules Medicare Set Aside (MSA) rules confuse many people. Recently, I posted on Medicare Set Asides (MSA or WCMSA). I received quite a few questions on how to quickly tell if MSA’s are necessary or not or Workers Comp files. I have seen flowcharts online that

Workers Comp Medicare Set Aside Concerns

Workers Comp Medicare Set Aside (WCMSA) There are a few concerns that I have concerning my last post on Workers Comp Medicare Set Aside. The info from the CMS website is in italics. Annuities  Payout totals for all annuities to fund the above expenses should be used rather than cost

Will Feds Control Workers Comp In Future or Just States?

Will The Feds Control Workers Comp In 10 Years? In the future,  will the  Feds control Workers Comp. In my last post, I commented on how the Federal Government, namely CMS, is encroaching on the state-by-state sovereignty of Workers Compensation. The CMS is basically overvaluing Workers Compensation pharmacy benefits. The

Is CMS Overpricing Workers Comp Future Pharmacy Benefits?

Is CMS Overpricing Workers Comp Future Pharmacy Benefits? Does the CMS inflate Workers Comp future pharmacy payouts?   A trend in Workers Comp claim settlements is slowly changing the landscape of closing out files. Many insurance carriers, TPA’s, Captives, etc. are rejecting the Center for Medicare/Medicaid Service’s (CMS) valuation of

Death of Workers Comp – CMS Now Runs FIO

CMS Now Runs FIO The CMS runs FIO – should this be death of Workers Comp?   OK, so the title is meant to catch your attention. The second part is actually a reality as of last week. The federalization of Workers Comp remains an issue. Yes, the CMS –

CMS Confuses Me Once Again With Medicare Part D

Once Again The CMS Confuses Me Again the CMS confuses me.  In many of the LinkedIn and other discussion boards on Workers Compensation, the comments are flying. There is a supposed insider memo from the CMS that indicates how the drugs that are disapproved by Medicare Part D should not

CMS Press Release on Medicare Set-aside Arrangements Delay

CMS Press Release on Medicare Set-Aside Arrangements Recently, the CMS Press Release on medicare set-aside arrangement was released.  The following is the press release from the CMS website on the insurer TPA reporting requirements. This was the result of the memo covered in my previous post. I also added in

Dreaded CMS Memo Round 2 – Users Guide – Confusion Reigns

User’s Guide – Help with Dreaded CMS Memo The dreaded CMS Memo now has a User’s Guide.  I had previously written about the Center for Medicare and Medicaid Services (CMS) requiring that all the states begin report all of their Workers Comp data to the CMS on January 1, 2010.

Medicare Set asides – Federalization of Workers Compensation

The Federalization of Workers Compensation – Medicare Set-asides The medicare set-asides rules have been law for quite a few years.   I have posted often on this subject lately as I think we are seeing the trees in the forest. I want to try to examine the forest in the Workers

Medicare Set asides – Possible No Statute of Limitations

Medicare Set asides May Never Close Out The Medicare set asides possibly possess no statute of limitations.  We have received a large number of questions on my last post. I thought it was best to post the excerpt from the town hall meeting to make sure all of my readers

CMS Medicare Set-aside Arrangements No Statute of Limitations

CMS Medicare Set-aside Arrangements No Statute of Limitation A CMS Medicare Set-aside Arrangements announcement was published today.  The CMS announced a very serious revelation on their authority.   CMS is an acronym for the Center for Medicaid/Medicare Services.   Recently, I had posted a few times on the Centers for

CMS Dreaded Medicare Set-aside Arrangement Memo – Meaning?

CMS And the Dreaded Medicare Set-aside Arrangement Memo The Dreaded Medicare set-aside arrangement memo was produced by CMS a few months ago.  Over the past week, I have covered the Centers for Medicaid/Medicare Services (CMS) Medicare Set-aside agreements and how CMS changed the playing field with its 7/1/09 memo to

Dreaded Medicare Set-aside Agreement Memo From CMS

CMS and Dreaded Medicare Set-Aside Agreement Memo What are the CMS and the dreaded medicare set-aside agreement memo effect on workers compensation? On July 1, 2009 the Center for Medicaid/Medicare Services (CMS) issued an innocuous-looking memo that will likely result in sanctions by the Federal Government and many lawsuits. In

Definition Workers Compensation Medicare Set-aside Arrangements

Workers Compensation Medicare Set-aside Agreements Explained Benefits for Workers Compensation Medicare expenses must be protected for the CMS. It is the responsibility of all parties to protect Medicare’s interests when resolving cases with future medical expenses. Forecasting future Workers Compensation medical benefits can be very complicated. The recommended method for

Workers Compensation MSA Claims Monitoring – Threshold Key

Monitoring Workers Compensation MSA Claims I received a question about how to monitor workers compensation MSA claims for Workers Comp. Please check the last post for the definition of a Medical Set Aside or MSA claim. The best way to monitor the MSA – sometimes called WCMSA is to examine

WCMSA – Workers Compensation Claims Premiums Federalized 1980

WCMSA – How Workers Compensation Became Federalized The WCMSA rules by The Center For Medicare/Medicaid services (CMS  have been in place for years.  I received a large number of questions on the subject of Workers Comp Medical Set Asides (MSA’s). The previous article on MSA’s was the most popular article



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