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How employers can avoid potential pitfalls dealing with Medicare liens and set-asides

For employers and insurers, Medicare Secondary Payer compliance rules are complicated, often causing delays and additional expenses that add to workers compensation claims costs.

  1. Identify & Analyze

    Costly and tricky process for payers

  2. Evaluate & Implement

    Navigating Medicare recovery rules

  3. Monitor & Adjust

    Risks, rewards of Medicare compliance strategies

As the Centers for Medicare and Medicaid Services prepares rules on Medicare Secondary Payer compliance, sources say CMS isn't working quickly enough to implement changes to ease workers compensation and liability claim settlements. ›› More

Grim employment prospects for some U.S. residents have caused Social Security disability benefit applications to surge, which has ramifications for workers compensation claims payers. ›› More

With Congress set to adjourn in December, insurance insiders said they still hoped lawmakers would push through two bills intended to alleviate common Medicare Secondary Payer issues. ›› More

Recent court rulings have given Medicare Advantage insurers increased authority to seek reimbursement for medical payments they've made on behalf of Medicare beneficiaries. ›› More

CINCINNATI—A federal appeals court decision that allows Medicare to claim nearly half of a man's liability settlement could hinder insurers' ability to settle such claims and may be an issue that reaches the U.S. Supreme Court. ›› More

While the Centers for Medicare and Medicaid Services is considering whether to issue new rules for Medicare set-asides in liability claims, experts say the agency's recent memo also could affect workers compensation settlements. ›› More

Roy Franco, co-chair of the Medicare Advocacy Recovery Coalition, says that the Medicare set-aside is probably a wise choice to protect Medicare in certain situations, so long as it is approved or defensible in some form when placed under scrutiny. ›› More

Editor's Picks: Online Solutions & Resources

CMS Primary Plan Audits Expected in 2013

The CMS is gearing up to start primary plan audits for MSP and MIR compliance as early as next year, as noted in the Office of the Inspector General (OIG) Fiscal Year 2013 Work Plan. This Franco Signor blog post offers details.

A bill that would ease the Medicare Secondary Payer reimbursement process for workers compensation settlements has been introduced in Congress. ›› More

Medicare too frequently rejects the monetary amount that workers compensation payers propose setting aside in trust for injured workers' future medical costs, employers, insurers and claimant representatives say. ›› More

Experts in Medicare Secondary Payer compliance say it has become easier for insurers and employers to settle some workers compensation claims since the Centers for Medicare and Medicaid Services began using a new contractor to review Medicare set-asides. ›› More

Some Medicare secondary payer experts say they are forgoing government approval of Medicare set-asides in workers compensation settlements to prevent delays and reduce costs for claims. ›› More

A bill that aims to ease Medicare Secondary Payer Act compliance passed the U.S. Senate late Friday and is awaiting President Barack Obama’s signature. ›› More

H.R. 1845, a bill that aims to simplify compliance with the Medicare Secondary Payer Act, has been signed into law by President Obama. ›› More

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Reimbursing Medicare: Addressing Medicare Conditional Payments as Part of Claims and Settlement Practices

Mark Popolizio of Crowe Paradis Services Corp. explains Medicare conditional payments and Medicare reimbursement rights in this California Self-Insurers Association newsletter article.

Humana Inc. has filed four federal lawsuits against Farmers Insurance Group of Cos. arguing that it is entitled to reimbursement from Farmers for benefits that Humana paid for Medicare Advantage and Medicare Part D plans. ›› More

Insurers and self-insured employers who forgo government approval of Medicare set-aside agreements can limit their potential liability by being conscientious in how they structure set-aside accounts, experts say. ›› More

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Four Reasons to Avoid the CMS Approval Process for MSAs

In her Workers Compensation Law Community blog post, Teddy Snyder, esquire at Ringler Associates in Beverly Hills, Calif., outlines the reasons why she recommends avoiding the CMS approval process.