Hospital Liens vs. Debts: A Distinction with a BIG Difference
Latest from Synergy Blog
Post-Settlement Conditional Payment Issues in Workers’ Compensation Claims
Rasa Fumagalli JD, MSCC, CMSP-F
The conditional payment recovery process in a workers’ compensation claim is not always smooth. Although the workers’ compensation insurance carrier will generally resolve any conditional payments in an accepted claim, the injured employee and counsel may find themselves in receipt of a post-settlement conditional payment notice or demand that identifies the injured employee as owing reimbursement to Medicare. This article will provide an overview of the conditional payment recovery process and identify ways to help you better navigate this process.
The obligation to address conditional payments stems from the Medicare Secondary Payer Act. It prohibits…
White Paper: Hospital Liens Carry Ethical and Legal Obligations but present Opportunity for Deep Reductions
April 22, 2021
Michael D. Walrath, Esq.
Direct provider “liens” against settlement proceeds have teeth, whether hospital or physician liens, statutory or contractual. The various positions of state bar associations on these issues, and the limited law delineating them, have historically been ever shifting and evolving but two things are clear. Liens must be released prior to settlement and deep discounts are available. Learn more by downloading the white paper below.
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The post Synergy Blog first appeared on Synergy Settlements.…
Beware of Problematic Medicare Secondary Payer Compliance Settlement Terms
The Evolution of The Workers’ Compensation Medicare Set-Aside (WCMSA) Arrangement
April 8, 2021
Rasa Fumagalli JD, MSCC, CMSP-F
The nature of the Workers’ Compensation Medicare Set-Aside (WCMSA) has evolved over the years since the 2001 Patel Memo. That evolution has seen us move from every WCMSA that met the Center for Medicare and Medicaid Services (CMS) internal workload review threshold being submitted to CMS for review, to now a practitioner may be offered an evidence-based medicine WCMSA, a “certified” WCMSA or a compromise WCMSA. An understanding of the differences between these various types of proposed WCMSAs and their projection methodology is important when it comes to settlement discussions.
The WCMSA…
The PAID Act: Transparency in Medicare Part C and D Enrollment Would Improve Medicare Benefit Coordination
Read about the PAID Act, now law, in an article co-authored by Synergy’s CEO, Jason Lazarus. The PAID Act helps resolve the hidden lien problem with Medicare Advantage Plans (MAOs – Part C).
You can read the article, featured by NAMSAP here.
The post Synergy Blog first appeared on Synergy Settlements.…
While Fighting for the Families You Represent, Don’t Forget to Protect Your Fees from the Tax Man
Medicare Secondary Payer Compliance Challenges in WC Cases
March 11, 2021
Rasa Fumagalli JD, MSCC, CMSP-F
Medicare Secondary Payer compliance issues in workers’ compensation cases are generally straightforward when the parties seek review of the Workers’ Compensation Medicare Set-Aside (WCMSA) proposal and proposed settlement by the Centers for Medicare and Medicaid Services (CMS). Oftentimes the employer/carrier will elect to fund the CMS-approved WCMSA in connection with the settlement. If the settlement also includes the injury-related, non-Medicare covered future medical expenses and other incidental damages, the injured employee’s attorney has fully maximized his/her client’s recovery for future medicals. But what about situations where an employee will require future injury-related,…
Electronic Payment Feature of Medicare Secondary Payer Recovery Portal (MSPRP)
February 23, 2021
Rasa Fumagalli, JD, MSCC, CMSP-F
The Centers for Medicare & Medicaid Services (CMS) agency has made significant improvements over the years in their online self-service tools for Medicare beneficiaries, their representatives, insurers, and recovery agents. Beneficiaries may obtain detailed information regarding their claims by registering on the MyMedicare.gov website. If the beneficiary has a third-party claim, he or she can access the Medicare Secondary Payer conditional payment information from their MyMedicare page or by entering the Medicare Secondary Payer Recovery Portal (MSPRP). Click here to see the MSPRP User Guide.
Today, the MSPRP allows beneficiaries and their…
Binding CMS to its WCMSA Determination
February 11, 2021
Rasa Fumagalli, JD, MSCC, CMSP-F
Securing CMS review of a Workers’ Compensation Medicare Set-Aside (WCMSA) proposal can, at times, be cumbersome. Once the CMS WCMSA determination letter is received, parties may often just close their files after the settlement funds are disbursed. This brief article will address the frequently overlooked CMS determination finalization process.
Parties that seek CMS review of a WCMSA should follow the guidelines that are set forth in CMS’ WCMSA Reference Guide (Guide). The most current version of the Guide, Version 3.2 was released on October 5, 2020, and outlines the process used by…