The Centers for Medicare and Medicaid Services (CMS) recently announced a town hall “to discuss common Commercial Repayment Center (CRC) NGHP ORM Recovery topics.”  The town hall will be held on Tuesday, January 14, 2020 (There is a typo in…

In a 11/26/2019 Alert, the Centers for Medicare and Medicaid Services (CMS) announced that the 2020 recovery threshold for liability, no-fault and workers’ compensation settlements will remain at $750. Accordingly, Total Payment Obligations to the Claimant, TPOCs, in the amount of…

Almost a year ago the U.S. Office of Management and Budget posted two rulemaking notices from the Centers for Medicare and Medicaid Services (CMS) entitled Civil Money Penalties and Medicare Secondary Payer Reporting Requirements and Miscellaneous Medicare Secondary Payer Clarifications…

CMS recently released Version 3.0 of its WCMSA Reference Guide, what we informally call the “MSA bible.”  The reference guide provides most CMS policy and procedures relating to its review of Workers’ Compensation Medicare Set-Asides. The updated guide can be…

Some employers, carriers and other payers think Medicare Set-Asides (MSAs) are all pretty much the same, a commodity.  A company calculates future medical expenses and sends a report with an allocation to the Centers for Medicare and Medicaid Services (CMS),…

In an October 10, 2019 decision from the U.S. Court of Appeals for the Ninth Circuit, the California Insurance Guarantee Association (CIGA) was found not to be a primary plan under the Medicare Secondary Payer (MSP) Act.  The result of…

On October 7, 2019, the Centers for Medicare and Medicaid Services (CMS) released an updated Workers’ Compensation Medicare Set-Aside Portal (WCMSAP) User Guide (Version 5.9) which adds the capability for both MSA self and professional administrators to electronically submit annual…

In light of the positive response to our July webinar, “Everything you wanted to know about MSAs, but were afraid to ask,” Tower will tackle Medicare conditional payments and related topics in our next webinar, October 23 at 2 p.m….

The famed University of Alabama head coach, Paul “Bear” Bryant said, “when you make a mistake, there are only three things you should ever do about it: admit it, learn from it, and don’t repeat it.”  These wise words are…

On July 19, 2019, the Food and Drug Administration (FDA) approved multiple applications for the first generics of Lyrica (pregabalin). This follows the expiration of Pfizer’s patent on Lyrica at the end of June. The generic is expected to be…