Medicare Part C and D Recovery
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CMS Releases WCMSA Reference Guide v4.1 and Self-Administration Toolkit v1.6
by D. Dietz CMS recently published Workers’ Compensation Medicare Set-Aside (WCMSA) Reference Guide version 4.1, which is now available in the Download section of the Workers’ Compensation Medicare Set Aside...
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Medicare Advantage Plans: Navigating Conditional Payment Appeals
by P. Czuprynski Federal regulations require Medicare Advantage Plans (MAPs) establish an administrative appeal process that allows a Qualified Independent Contractor, an Administrative Law Judge, the Medicare Appeals Council, and...
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Exploring Different Processes for Medicare Liens: Parts A, B, C, and D
P. Czuprynski Earlier in March, as part of our complimentary knowledge series of webinars on Medicare Secondary Payer Compliance, we reviewed the different search and collection processes for Medicare Parts...
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Medicare Advantage Plans: PAID ACT – Year One
by P. Czuprynski Carriers and self-insureds, or their vendors, have the ability to ask Medicare if a particular claimant is enrolled in Medicare benefits through either an electronic data request or...
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Eleventh Circuit Finds Medicare Advantage Plans Subject to Four-Year Statute of Limitations for Private Cause of Action Claims
by B. Smith The Eleventh Circuit Court of Appeals dismissed a private cause of action claim brought by MSPA Claims 1 LLC (Plaintiff) against insurer Tower Hill (Defendants) finding that...
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Eleventh Circuit Holds Section 111 Reporting Can Establish Elements of Private Cause of Action Under MSP Act
by B. Smith The Eleventh Circuit Court of Appeals in MSP Recovery Claims, Series LLC v. Metropolitan General Insurance Company, et. al., Case No. 21-11547 (11th Cir. July 18, 2022),...