CMS has made the following updates to the MMSEA section of the CMS website: http://www.cms.gov/
September 30, 2010
- Posted the September 22, 2010 NGHP Town Hall Teleconference Transcript to the NGHP Transcripts section page.
- Moved the January 28, 2010 NGHP Town Hall Teleconference Transcript to the Mandatory Insurer Reporting section page under NGHP Transcripts.
- Moved the May 26, 2009 Alert: Compliance Guidance Regarding Obtaining Individual HICNs and/or SSNs for Group Health Plan from the What’s New section page to the GHP Alerts section page.
- Moved the August 24, 2009 – HICN, SSN Collection – NGHP Model Language from the What’s New section page to the NGHP section page.
- Moved the August 24, 2009 Alert – Compliance Guidance Regarding Obtaining Individual HICNs and/or SSNs for NGHP Reporting from the What’s New section page to the MMSEA 111 Alerts section page.
- Moved the May 27, 2010 – May 27, 2010 – Updating Language – ALERT For Liability Insurance (including Self-Insurance), No-Fault Insurance, and Workers’ Compensation RREs – Periodic Workers’ Compensation and No-Fault Payments from the What’s New section page to the MMSEA 111 Alerts section page.
Synergy can assist your firm with Medicare Compliance and understanding MMSEA Section 111 Reporting Requirements. Contact us today for more information on how we can benefit your firm! (877)907-5436 / info@synergysettlements.com.
Question:
Do the VA subrogation rights apply to UM coverage, or do they only apply to the responsible third-party?
Answer:
The right of the VA to recovery from UM is not a definite yes or no answer.
When the VA cannot recover:
In researching UM recovery in VA cases, we have to look to the language within the UM plan. According to Government Employees Insurance Co. v. Andujar, 773 F.Supp. 282, it was determined that the ability of the US (more…)
In CMS’ efforts to improve the quality of care, as of October 1, 2008 Medicare will not pay for certain injuries/conditions acquired during inpatient care, these injuries/conditions have been named by CMS as “never events” or “hospital acquired conditions” (HACs). CMS has advised state Medicaid Agencies to amend their statutory language to ensure that payment is not made through Medicaid for those beneficiaries that may have dual eligibility.
On February 8, 2006 President George Bush signed the Deficit Reduction Act (DRA) of 2005. Pursuant to Section 5001(c) of DRA the Secretary must identify the following conditions:“(a) high cost or high volume or both,
(b) result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis, and
(c) could reasonably have been prevented through the application of evidence-based guidelines.”
If any of the following conditions was not present at the time of admission additional payment will not be made by Medicare. In an attempt to enforce this rule CMS has created POA, which is a coding mechanism used to indicate when a HAC was present to prevent Medicare from being the responsible payer.
For FY 2009 the 10 categories of HACs include:
- Foreign Object Retained After Surgery
- Air Embolism
- Blood Incompatibility
- Stage III and IV Pressure Ulcers
- Falls and Trauma
- Fractures
- Dislocations
- Intracranial Injuries
- Crushing Injuries
- Burns
- Electric Shock
- Manifestations of Poor Glycemic Control
- Diabetic Ketoacidosis
- Nonketotic Hyperosmolar Coma
- Hypoglycemic Coma
- Secondary Diabetes with Ketoacidosis
- Secondary Diabetes with Hyperosmolarity
- Catheter-Associated Urinary Tract Infection (UTI)
- Vascular Catheter-Associated Infection
- Surgical Site Infection Following:
- Coronary Artery Bypass Graft (CABG) – Mediastinitis
- Bariatric Surgery
- Laparoscopic Gastric Bypass
- Gastroenterostomy
- Laparoscopic Gastric Restrictive Surgery
- Orthopedic Procedures
- Spine
- Neck
- Shoulder
- Elbow
- Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE)
- Total Knee Replacement
- Hip Replacement
CMS has opted to leave the list of HACs for FY 2010 unchanged. CMS will take this time to evaluate the program in order to assist with future decision making of the program.
Lien Settlement Solutions can assist your firm in understanding the changes in Medicare policies and guidelines. Call us today for more information on Medicare and Compliance at (877)907-5436 or email us at info@lienss.com. We are the Lawyer’s Complete Solution to Lien Resolution!
Question: “I am the executor of estate on behalf of my mother who was a Medicare beneficiary. This is a wrongful death case, so does Medicare have a lien in this situation?” – Florida Resident
Answer: According to the Medicare Secondary Payer Manual (Chapter 50.5.4.1.1), Medicare’s right to recover against a wrongful death claim depends on two things, 1. The beneficiary’s state of residence, and if the state law allows for the recovery of medical expenses in a wrongful death claim, and 2. If the state’s law allows for recovery of medical claims, the amount Medicare is entitled to recover against may vary (full recovery in some states, limited recovery in others). So basically, depending on where the beneficiary lived, there may or may not be an obligation to Medicare. Some states do not allow for the recovery of medical payments, so in those states Medicare cannot assert a claim against the deceased beneficiary or survivors.
I assume that you are in Florida, so I reviewed the Florida Wrongful Death Act (FL §768.14 – 768.26) in this state. In §768.21(6)(b) it states that medical expenses that have been charged to the estate are recoverable, and § 768.21(7) states, “All awards for the decedents estate are subject to claims of creditors who have complied with the requirements of probate law concerning claims”. Therefore, in Florida, Medicare does have a right to recover their claim against the estate of the beneficiary in a wrongful death case. My suggestion is that you discuss this matter with a probate attorney for further clarification on how to proceed in this case. Be advised that this is only a general response to your question, and should not be viewed as specific legal advice, as I am not an attorney. I hope this is helpful to you in your research. Please contact us at Lien Settlement Solutions have any more questions.
Lien Settlement Solutions has professionals that can assist with questions of compliance and lien validity in cases of Wrongful Death, Malpractice, Workers Compensation, and Liability. Feel free to call us with your questions at (877) 907-5436 or email at info@lienss.com!
CMS finds insurers requests for SSN’s appropriate for Section 111 MMSEA purposes: http://www.cms.gov/MandatoryInsRep/Downloads/RevisedCollectionSSNEINs.pdf
In order for CMS to accurately coordinate payments made by Medicare to ensure appropriate payment, Medicare requires the HICN (Health Insurance Claim Number) or the SSN and the EIN (Employer Identification Number). Medicare has collected this information from beneficiaries since the inception of the Medicare program. This information is used for the administration of the Medicare program, the beneficiaries personal information is protected by the Privacy Act of 1974 and the Health Insurance Portability and Accountability Act Privacy Rule.
CMS’ clarification of the appropriateness of request/release of this information arises from overwhelming concerns of the plaintiff and plaintiff attorneys. What will the defense do with this information once it has been provided? Section 111 requires the SSN if the HICN is unavailable if the insurers are unable to report to the COBC (Coordination of Benefits Contractor). Could the “plaintiff” be found non compliant under Section 111 for not providing the requested information for accurate reporting of claims? This is yet to be determined.
As stated by CMS the, “collection of HICN’s, SSN’s, and EIN’s for purposes of compliance with the reporting requirements under Section 111 of Public Law 100-173 is appropriate.”
Lien Settlement Solutions can assist your firm in navigating MMSEA Guidelines and Medicare Compliance. For more information about Medicare Compliance and Lien Resolution, contact us at 1(877)907-5436 or info@lienss.com.
QUESTION:
Will the new Health Care Reform Law have any affect on ERISA plans and subrogation in the future? – FL Attorney
ANSWER: Right now there are many unknown variables regarding ERISA plans and the new Patient Protection and Affordable Care Act of 2010 that was signed into law on March 23, 2010. What we do know is that health insurance practices, including Subrogation and Recovery will experience changes over the next few years. The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets minimum standards for most voluntarily established pension and health plans in private industry to provide protection for individuals in these plans (US Department of Labor, www.dol.gov). Employer provided health plans are governed by ERISA, which also loosely defines their right of recovery, allowing for “appropriate equitable relief” (29 USC 1132(a)(3)). Plans that are self funded by the employer are evaluated based on federal ERISA law for validity. However, it is reported that over the coming months, the Department of Health and Human Services will be conducting a study to evaluate the financial solvency and ability by self funded companies to provide consistent benefits during times of economic downturn, along with several other markers (www.myhealthguide.com). This may mean a change in the classification of employer provided plans from self – funded (under federal law) to insured plans, which are evaluated against state insurance law. Next year, in 2011, insurance plans will be required to provide specific plan descriptions (SPD) and coverage information in plain, easy to understand language with, definitions, and common sense examples in a uniform format (www.myhealthguide.com). This will allow for a clearer understanding of the subrogation rights and parameters in plain terms for evaluation per Sereboff v. Mid Atlantic Medical Services, Inc. (2006), where the plan’s recovery is defined by the specific language within the plan. It will be more important than ever to obtain a copy of the specific plan description for the year of coverage to which the claimant was injured. Paying attention to these detais may make all the difference in your settlement, and may save money for your client.
As more information about the changes to ERISA Lien Resolution and Subrogation are released, we will continue to assist in the understanding of the new measures. Lien Settlement Solutions offers ERISA, Private Insurance, and Hospital/Provider Lien Resolution Services. Contact us at (877)907-5436 or email at info@lienss.com for more information.
The Reviews Are In! Synergy’s Lien Resolution unit opened its doors in June 2009, with the purpose of providing complete lien resolution services to the trial bar. We make a special effort to be an advocate for our clients, and achieve the best possible results on their behalf. Well, now our clients have spoken! Here are a few testimonials! “I have been working with Synergy for the past nine months. I am very satisfied with the results [they have] accomplished for our firm on several of our cases.” Rosario Ingles, Closing Case Manager – Law Offices of William Ruggiero “Synergy was extremely knowledgeable and effective in assisting to reduce our client’s insurance lien. The staff was a pleasure to work with, extremely professional, and went above and beyond the scope of our expectations. Many times, throughout our case, [they] worked after business hours to accommodate our needs. The end result was a huge savings for our client and we hope to utilize her and the company in the future.” Joni Hautamaki – Didier Law Firm Call us today to see how we can assist in your case management! (877)907-LIEN (5436).
Important Information for Resolving Liens in Asbestos Cases. Asbestos Exposure cases are unique when it comes to lien resolution because of factors that are unlike any other type of litigation. Unlike a pharmaceutical case where the illness develops within a 1-3 year period, most asbestos-related diseases are diagnosed decades after the initial exposure. By the time Mesothelioma or Asbestosis are detected, the claimant is usually a retiree. In managing an Asbestos caseload, it is important to know what the lien obligations are, especially when dealing with multiple defendants. Origin of exposure, military service, dates of exposure, and whether the exposure is from a primary or secondary source are all important factors that impact the resolution of health insurance liens. 
Due to the 15 – 40 year latency period for the development of Mesothelioma, and 10 – 20 year latency period for Asbestosis, most asbestos claimants are over the age of 65. Many claimants receive Medicare, Medicaid, and VA health care benefits. It is important to know the recovery rights of these insurers before going forward with your case. (more…)
Medicare claim denial is unfortunately a common problem that Medicare beneficiaries are faced with. Medicare has the highest denial rate of any insurer pursuant to the 2008 National Health Insurer Report Card commissioned by the American Medical Association (AMA, www.ama-assn.org):
![DenialsByInsurer2008[2]](http://www.liensettlementsolutions.com/lienresolution/wp-content/uploads/2009/10/DenialsByInsurer20082.jpg "DenialsByInsurer2008[2]")
Before we start making hasty assumptions about government health care programs, lets look at some of the reasons why claims have been denied by Medicare. 33.6% of adjustments and 33.7% of denials are due to inaccurate reporting by the providers. Some of the common billing errors that providers make are: (more…)
