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We are currently scheduling webinars to cover a variety of Medicare Compliance related topics over the next few months. If you need CEU credit for any state, please click here to contact us and let us know which state.  In addition, please note whether you have a preference for a specific topic. You may also visit our website by clicking here to request a webinar that is customized to meet your specific needs.

CMS Releases Revised User Guide for WCMSAs

CMS just released a newly-revised WCMSA User Guide.  The revisions include:

-  Addition of Section 4.1.4 concerning Hearings on the Merits of Cases;

- Clarification of initial submission requirements for medical records and payment records;

-  Miscellaneous modifications including removal of a reference to Drug Tables for physician-dispensed drugs and combination of User Guide sections on Drug Tapering and Drug Weaning;


-  Addition of Wisconsin to the list of states with no WC fee schedule; and

-  Addition of Appendix 6 which lists changes made in previous versions of the WCMSA User Guide.

The newly added section 4.1.4 provides as follows concerning a Hearing on the Merits of a Case:  

When a state WC judge approves a WC settlement after a hearing on the merits, Medicare generally will accept the terms of the settlement, unless the settlement does not adequately address Medicare’s interests. If Medicare’s interests were not reasonably considered, Medicare will refuse to pay for services related to the WC injury (and otherwise reimbursable by Medicare) until such expenses have exhausted the dollar amount of the entire WC settlement. Medicare also will assert a recovery claim if appropriate.

If a court or other adjudicator of the merits (e.g., a state WC board or commission) specifically designates funds to a portion of a settlement that is not related to medical services (e.g., lost wages), then Medicare will accept that designation.

Let us know if you have any questions concerning these revisions.  To access the complete, revised WCMSA User Guide, click here.

Complimentary Medicare Secondary Payer Act Compliance Audits

Is your company in compliance with ALL of the requirements of the Medicare Secondary Payer Act?

Are you handling Medicare conditional payment claim/past lien research and resolution properly?

Do you adequately address Medicare's interests or utilize Medicare Set-aside Arrangements in appropriate cases?

Are you reporting cases pursuant to Section 111 timely and accurately?

Do you have a policy in place concerning each of these issues?

If you do have a policy in place, is it understood and followed by those dealing with claims on a daily basis?

If you aren't absolutely certain that the answer to each of these questions is yes, we can help you figure it out!  Click here to contact us today regarding our complimentary Medicare Secondary Payer Compliance Audits.