Work-Accident -Compensation Accident Claim Work: CMS

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Jumat, 06 Januari 2012

Baby Boomers Have Work Comp Claims Too

A recent study confirms that Baby Boomers are unfortunately not claiming workers' compensation benefits at a higher rate than younger workers. What the report doesn't reveal is that older disabled workers are being shifted to the Social Security system for medical benefits at a higher rate than ever before.

NCCI, with its private data, seems to ignore the fact that cost shifting is still occurring from workers' compensation insurance coverage to the general taxpayer by the utilization of Medicare. Until CMS finally shuts the door once and for all, older workers are going to take the easier path for benefits through Medicare. Medicare leaves the choice of doctors and the number of physicians to the patient.

At this point in time, the few senior workers who do file compensation claims for injuries superimposed on general deteriorating medical conditions, are being denied work comp due to pre-existing conditions and age related deterioration. It "used to be" that workers' compensation "took the worker as they found him (her)," but that has changed through the insurance company initiated legislative efforts in a majority of jurisdictions.

Until such time as the workers' compensation system becomes user friendly to senior workers, those workers will be left out of the compensation system and will not realize the additional benefits of temporary and permanent partial or total disability benefits. Under the current system the senior workers, and the general taxpayer, are the big losers. The system needs to be reversed so that workers' compensation becomes a winning solution to the problem.

Read more about the baby boomers who are working: In a Second Career, Working to Make a Difference
“The concept of retirement is fading,” said Mary S. Bleiberg, ReServe’s executive director. “There is a steady increase in people over 65 going into or staying in the workforce. People are realizing they’re going to be around a lot longer, and there’s a limited number of golf clubs they can swing.”
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Selasa, 03 Januari 2012

Annual Reporting of WCMSA Account Expenditures

Address for submitting annual accounting documentation to CMS' Medicare Secondary Payer Recovery Contractor (MSPRC). Please send your completed annual Workers' Compensation Medicare Set-aside Arrangement (WCMSA) Account Expenditure accounting documentation to the CMS lead Medicare Contractor at the address below:

MSPRC - Non-Group Health Plan (NGHP)
P.O. Box 138832
Oklahoma City, OK 73113

Selasa, 22 November 2011

CMS Sets Telephone Conference Call to Discuss Workers' Compensation Medicare Set-aside Portal

The Centers for Medicare & Medicaid Services (CMS) has completed its Pilot Testing of the Workers' Compensation Medicare Set-aside Portal (WCMSAP). The CMS will be conducting a Town Hall conference call on November 29, 2011 from 1:00 to 3:00 pm (EST), to introduce this initiative to submitters of proposed Workers' Compensation Medicare Set-Aside Arrangement (WCMSAs) amounts, and to answer questions regarding the WCMSAP. After the Town Hall conference call, CMS will post the links of the WCMSAP application, and the WCMSAP Computer Base Training (CBT) Modules, on the Workers' Compensation Medicare Set-aside Portal (WCMSAP) section page "Related Links Outside CMS."

Please Note: The call in information for the WCMSAP Town Hall teleconference is:
Call in time: 1pm to 3pm
Call In Line: 1-(800) 603-1774
*Conference ID: 29840615

*Participants must use the Conference ID number to be allowed into the call.

Senin, 31 Oktober 2011

It is All The Same Apple

Another challenge to the Medicare Secondary Payer Act (MSP) has been introduced (H.R. 1063 in Congress. This is yet another attempt to bounce the dead cat on the floor.

The legislation is the third reiteration by insurance companies, and the cottage industry that has emerged to service conditional payment resolution. It is most likely doomed to failure reflecting the quick death of its predecessors and the worsening economic times.

Since the enactment of the MSP in 1980, there has been a slow, yet pervasive and effective effort by the US government to stop the shifting ofmedical costs from the workers’ compensation system onto the shoulders of the Medicare system.

Medicare has its own solvency problems, not withstanding cost-shifting by the workers’ compensation system. Medicare is trying to serve a growing constituency as costs soar and the base of available of income to tax dwindles. Medicare costs have become a major target for the “Super Committee” in Congress for cost reduction.

Statistics also reveal that the aging workforce is continuing to fall apart physically and file for Social Security Disability Insurance in lieu of workers' compensation at a greater rate than ever.. Even though more attention is now directed to major diseases such as cardio-vascular, cancer and diabetes, the aging bodies of the senior citizen population continue to need more medical care due to wear and tear alone. The barriers established through so-called reformed efforts have blocked the follow of new occupational disease cases into the workers' compensation system.

The aging workforce looks to Social Security Disability Benefits and Medicare as a more effective remedy, and one that takes precedence over applications for workers’ compensation. Fewer seniors, and those approaching that age, opt for workers’ compensation benefits. This pattern even puts more fiscal strain on the present Social Security and Medicare system.

Medicare is really not a free-ride for seniors and the government. While workers and their employers have made contributions for a lifetime, the system consume a large portion of the nation's economic wealth. Two major hospitalizations by a beneficiary exhaust all the individual and employer economic contributions completely from the reserves, and the government is stuck covering excess bills for the individual's lifetime.

As the US government continues to mandate stricter reporting and payment procedures the state workers’ compensation programs as the state programs to become further stressed by the Centers for Medicare and Medicar Services (CMS) reimbursement procedures. Both the federal and state systems have the same goal of providing assistance to disabled workers and their families.

As each continue to battle for a resolution of their own economic issues, they are merely shooting each other in the foot and weakening the entire purpose of each of their noble missions. Until a more unified system is established, it is incumbent upon both programs to direct their efforts to designing a more non-contentious system of resolution.

The mandatory arbitration of the cost medical reimbursement would be an interim step so that the workers’ compensation administrative process could go forward unimpeded. The problem of funding medical costs for the population should be considered one apple, and taking bites at it from every direction will merely result in a total deterioration of the entire process.

Jumat, 30 September 2011

CMS Announced Status Update and Future Changes

As part of the Centers for Medicare & Medicaid Service (CMS) efforts to continuously improve its Medicare Secondary Payer (MSP) program; CMS has posted the following information to the MSP websites:

1) An ALERT delaying the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) Section 111 MSP reporting requirement for certain liability insurance (including self-insurance) settlements, judgments, awards, or other payments is now posted at www.cms.gov/MandatoryInsRep.

2) Policy guidance related to Exposure, Ingestion, and Implantation issues, and December 5, 1980, is now posted at www.cms.gov/MandatoryInsRep and www.cms.gov/COBGeneralInformation.

3) An ALERT related to Qualified Settlement Funds, under Section 468B of the Internal Revenue Code, is now posted at www.cms.gov/MandatoryInsRep.

4) A policy memorandum, for liability insurance (including self-insurance), on the acceptance of the treating physician's certification, and its impact on the issue of protecting Medicare's interests with respect to future medicals is now posted at www.cms.gov/COBGeneralInformation.

In addition, on September 30, 2011, the MSPRC will implement a self-service information feature to its customer service line. This feature gives callers the ability to get the most up-to-date Demand/Conditional Payment amounts, and the dates that those letters were issued, without having to speak to a customer service representative. The self-service feature will be available for extended hours, and callers will have the option of requesting information on multiple cases during one phone call.

Beginning in October 2011, CMS will implement an option to pay a fixed percentage of certain physical trauma-based liability cases with settlement amounts of $5000 or less. Detailed information on this option will be posted as an ALERT, on or before October 21, 2011, on the MSPRC website at www.MSPRC.info.

Upcoming improvements to the MSP program, expected within the next 3-9 months, include the following:

• The implementation of a MSPRC portal, where the beneficiary/representative can obtain information about Medicare's claim payments, demand letters, etc., and input information related to a settlement, disputed claims, etc.

• The implementation of an option that allows for an immediate payment to Medicare for future medical costs that are claimed/released/effectively released in a settlement.

• The implementation of a process that provides Medicare's conditional payment amount, prior to settlement in certain situations.

Jumat, 08 Juli 2011

Workers’ Compensation Medicare Set-Aside Portal (WCMSAP)

The Centers for Medicare & Medicaid Services (CMS) is currently Pilot Testing the Workers' Compensation Medicare Set-aside Portal (WCMSAP), a web-based application. This new initiative will allow submitters of Workers' Compensation Medicare Set-Aside Arrangements (WCMSAs) to directly enter case information, upload documentation, and receive case status information through the use of a secure Web portal.

This secure Web portal will greatly improve the efficiency of the submission process for WCMSAs, including receipt of the proposal by its Workers' Compensation Review Contractor (WCRC). The WCMSAP, a web-based application, will allow attorneys, beneficiaries, claimants, insurance carriers, representative payees, and WCMSA vendors to:

• Create a work-in-progress case
• Submit WCMSA cases
• Perform case lookups
• Append documentation to a case

Rabu, 22 Juni 2011

Congress Told CMS Must Continue to Stop Work Comp Cost Shifting

At a House Oversight hearing today it was revealed that over the last decade the Centers for Medicare and Medicaid Service (CMS) has obtained over $50 Billion in reimbursement under the Medicare Secondary Payer Act (MSP). CMS has worked diligently to stop cost shifting from workers' compensation insurance carriers to the US taxpayer.

Deborah Taylor, Chief Financial Officer and Director, Office of Financial Management Centers for Medicare and Medicaid Services, stated, "Any restrictions on existing MSP rights or recovery processes would adversely affect savings that would otherwise accrue to the Medicare Trust Funds through MSP recovery activities, as well as the $1 billion per year in cost-avoided savings that CMS is able to track. Proposals that would impose mandatory process changes may affect Medicare’s status as a secondary payer or its priority right of recovery, as well as CMS’ ability to prioritize its own workload. These changes may also have the unintended effect of undercutting the underlying intent of the statute, increasing costs, and reducing existing savings. "

Ms. Taylor concluded by stating that, "...CMS is committed to a transparent MSP process that ensures that beneficiaries receive the care they need, while reducing Medicare payments for claims that are the legal responsibility of a group health plan, NGHP, or other responsible party. We understand that the MSP process can present challenges to all involved in coordination of benefits between Medicare and other payers. We are committed to maintaining a strong line of communication with beneficiaries, insurance and workers’ compensation plans, and other stakeholders on MSP policy in general, as well as the new Section 111 reporting requirements. Additionally, we will look to expand and strengthen our training and education opportunities where possible. CMS looks forward to working with our partners and beneficiaries in the future to preserve the integrity of the Medicare program and secure the Medicare Trust Funds for future generations. We look forward to working with Congress as well on these important goals."

Related Resources

Medicare Secondary Payer: Process for Situations Involving Non-Group Health Plans, US GAO Study James C. Cosgrove, Director, Health Care - 6.22.11

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Rabu, 25 Mei 2011

Halted: Medicare Secondary Payer Recovery Contractor Demand Letters

The Medicare Recovery Contractor (MSPRC) has now posted a notice on its web site that, "...Issuance of the Rights and Responsibilities (“RAR”) and Demand letters has been temporarily suspended while these letters are under review. The MSPRC is still working cases, and the RAR and Demand letters will be mailed out once appropriate revisions have been made."

This follows a recent US District Court ruling enjoining CMS's collection procedures. Haro v. Sebelius, (A. Ariz.) CV 09-134 TUC DCB

Click here for Court Order entered May 5, 2011.

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Selasa, 24 Mei 2011

Court Permits Deduction of Procurement Costs From Medicare Set-Aside in Liability Claim

Following the guidelines of the CMS Management Memo entitled "Medicare Secondary Payer - Workers Compensation (WC) Information" dated May 7, 2004, and the interpretation of 42 CFR 411.37, a NJ Court granted an attorney the deduction of procurement costs from a Medicare Set-Aside Trust.

"This court's decision to apply 42 C.F.R. § 411.37 to funds obtained in a civil action and placed in a Medicare set aside is also in line with general principles of equity. Where a plaintiff is, or will within a short time become, a Medicare recipient, the plaintiff's attorney also works on behalf of Medicare to secure funds to pay future medical expenses Medicare would otherwise pay. To allow Medicare to avoid paying an equitable share of the procurement fees for a judgment or settlement amount, forcing the plaintiff to cover all the fees, would be unfair to plaintiffs. In some situations, a plaintiff may end up getting nothing after creating the set aside and paying attorneys' fees or may even have to pay money out of pocket to his attorney after a lengthy trial. Such a result would not only be inequitable, it would deter persons on Medicare who are injured by the tortious acts of others from bringing claims."

Hinsinger v. Showboat Atlantic City, L-3460-07, 2011 WL 1885980 (NJ Super Law Division 2011), decided May 19, 2011.

Jumat, 18 Maret 2011

Industry Coalition Wants to Cut CMS Conditional Payments

A group of about 50 employers, insurance carriers and vendors have formed a coalition to endorse legislation (H.R.1063) introduced this week that would ease reporting requirements and reimbursement procedures of the Centers for Medicare and Medicaid (CMS). The organization, the Medicare Advocacy Recovery Group [MARC], contends that the proposed legislation will:

"Empowering Medicare to provide settling parties with the amount of their MSP repayment obligation during the settlement process, will allow taxpayers to settle quicker, and repay the Medicare Trust Fund faster.
"MSP Reform will provide a more affordable and less intrusive MSP system that protects beneficiaries and the Medicare Trust Fund, but does not waste limited judicial and other resources or needlessly confuse parties trying to settle a claim resulting from an injury to a beneficiary.
"MSP Reform will also eliminate the required use of Social Security Numbers (SSNs) and Health Insurance Claim Numbers (HICNs) in the reporting process, create a basic right of appeal for all parties to resolve a CMS MSP determination, clarify the statute of limitations, and require the CMS Actuary to determine a threshold below which the recoveries are so small it makes no sense to apply the complex MSP laws.

Theoretically it sounds like the change would create a more efficient system to establish: time limits for claim reimbursement; a statute of limitations for liability (3 years); an avenue for redress directly to the judicial system; and a threshold amount for reimbursement. However, the proposal would actually defeat the basic philosophy of the workers' compensation act.

The convoluted logic of the employer/insurance group just makes no sense. It is like saying that I didn't bother buying enough postage on a timely basis so I will just mail my letter at half-price. The universal legislative intent of workers' compensation act mandates that the employer is responsible for medical care of its injured workers. The insurance industry has tried other gimmicks before to continue its long history of cost shifting, and those have rightly failed as Congress wouldn't buy into them.

While employers and insurance carriers delay and deny compensation benefits, shifting the cost to the taxpayers through depletion of the Medicare system, is both offensive and repugnant. If the coalition wants to ride the carousel of "it's not how long, but how much," in doling out benefits, then they should not blame CMS for delays and penalties, caused by the coalition's own failure to report on a timely basis in the first place.

Rabu, 03 November 2010

Court Grants Motion to Reconsider Statute of Limitations in CMS Case

In order to avoid any "maifest injustice," the Court that had previously dismissed the Government's case against insurance companies and lawyers for failure to reimburse the Centers for Medicare and Medicaid Services (CMS), has granted a motion to reconsider under the plaintiff's accrual theory.

"As its fourth ground for reconsideration, Plaintiff argues that the court erred in concluding that the Government inadequately raised a theory of continuing accrual against all defendants concerning the annual $2.5 million payments from 2004 through 2014 contemplated in the Abernathy Settlement Agreement. Admittedly, Plaintiff did not address this theory in its responsive briefing to the Defendants’ motions to dismiss. At the September 13, 2010 hearing, the court granted verbal leave for Plaintiff to submit a motion to amend its complaint to more clearly articulate a claim on this issue. For whatever reason, Plaintiff has failed to do so, but argues in its motion to reconsider that it properly pled a theory of continuing accrual in its First Amended Complaint and raised it at the hearing. Though this theory should have been raised and argued in Plaintiff’s brief in response to the multiple motions to dismiss filed by Defendants, the court will allow Defendants an opportunity to respond in full to this issue to avoid any possible clear error. Therefore, the court GRANTS Plaintiff’s motion to reconsider as to the issue raised in part D regarding a continuing accrual theory and ORDERS that Defendants have until Tuesday, November 16, 2010 to respond as to whether the allegations pled in Plaintiff’s First Amended Complaint are sufficient to state a claim for a theory of continuing accrual; and if so, whether the court committed clear error in dismissing Count VI of Plaintiff’s First Amended Complaint.

"Finally, the court RESERVES RULING as to the tolling issue raised in part E of Plaintiff’s motion to reconsider. To avoid any possible clear error and/or manifest injustice, the court will allow Defendants until Tuesday, November 16, 2010 to respond as to: 1) whether the court should reconsider the issue of tolling; and 2) if the court does, whether it committed clear error in application of the appropriate burden of raising or pleading tolling in this context and in granting the motion to dismiss before discovery had yet occurred.

USA v James J. Strickler, et al CV 09=BE-2423-E

For over 3 decades the Law Offices of Jon L. Gelman 1.973.696.7900 jon@gelmans.com have been representing injured workers and their families who have suffered work related accident and injuries.

Minggu, 11 Juli 2010

CMS to Rely on New Life Tables for Workers Compensation Set Aside Agreements

The Centers for Disease Control (CDC) has recently published its 2006 United States Life Tables. Effective July 19, 2010, the Centers for Medicare & Medicaid Services (CMS) will begin referencing the CDC's Table 1: Life table for the total population: United States, 2006, for WCMSA life expectancy calculations. This means that for any newly submitted WCMSA proposal received by CMS' Coordination of Benefits Contractor (COBC), or where any WCMSA case is reopened on or after July 19, 2010, CMS will apply the CDC's 2006 Table 1 for life expectancy calculations.

In 2006, the overall expectation of life at birth was 77.7 years, representing an increase of 0.3 years from life expectancy in 2005. From 2005 to 2006, life expectancy at birth increased for all groups considered. It increased for males (from 74.9 to 75.1) and females (from 79.9 to 80.2), the white (from 77.9 to 78.2) and black populations (from 72.8 to 73.2), black males (from 69.3 to 69.7) and females (from 76.1 to 76.5), and white males (from 75.4 to 75.7) and females (from 80.4 to 80.6).

Click here to read more about Medicare Secondary Payer Act and workers' compensation.

Click here for more information on how Jon L Gelman can assist you in a claim for workers' Compensation claim benefits. You may e-mail Jon Gelman or call 1-973-696-7900.

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For over 3 decades the Law Offices of Jon L. Gelman 1.973.696.7900 jon@gelmans.com have been representing injured workers and their families who have suffered occupational accidents and illnesses.

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