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Posts Tagged ‘Reform’

This Just In: MSPRC Announces $300 Threshold in Liability Cases

Wednesday, September 7th, 2011

A new alert was posted on the MSPRC.info website on September 6, 2011.  The MSPRC has announced a $300 threshold in liability cases that qualify based on the type of incident and settlement distribution. 

From www.MSPRC.info:

Beneficiary Alert: $300 Threshold on Liability Settlements

Medicare has implemented a $300 threshold for certain Liability Insurance cases. If all of Medicare’s criteria are met, the MSPRC will not recover against the beneficiary’s settlement, judgment, award or other payment.

If you’re a beneficiary, what does this mean for you?

As of September 6, 2011, if you’ve received a lump sum settlement of $300 or less, and your case meets certain conditions, Medicare will not recover from that settlement. These conditions include:

  1. Your settlement is related to an alleged physical trauma-based incident, not an alleged exposure, ingestion, or implantation, and
  2. You do not have any additional settlements related to the same alleged incident.

Please note that this threshold specifically excludes settlements where an insurer is paying your medicals bills directly or on an ongoing basis. This threshold also does not apply if a demand letter was already issued for your case. We have posted a more detailed explanation in the Attorney and Insurer Toolkits.

For more information on the $300 MSPRC Threshold, Medicare Secondary Payer, or any lien resolution issue, feel free to contact Lien Settlement Solutions at info@lienss.com or by phone, (877)907-5436 extension 2. 

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Posted in Lien Resolution, Medicare | 1 Comment »

Medicare Secondary Payer Reform… Could it be?

Wednesday, May 19th, 2010

On October 2, 2006 CMS consolidated all conditional payment recovery functions.  CMS transitioned from several recovery contractors nationwide to a single contractor in Chickasaw Nations Industry, LLC. (CNI).  This branch of CNI is the “Medicare Secondary Payer Recovery Contractor” (MSPRC).  Since 2006 the recovery process has improved, but the frustrations involved with resolving Medicare conditional payments still linger.  BUT, could change be coming soon?  A Federal Court Judge has granted action to proceed in a potential class action suit.  The suit will challenge the MSPRC’s recovery procedures.

As explained by Jon L. Gelman:

“The case pending in Arizona questions the authority of the HHS to seek reimbursement in liability claims of conditional payments paid by the Federal government. The plaintiffs are seeking declaratory and injective relief from the HHS procedures. They allege that the HHS has exceeded its authority under the MSP and that the plaintiffs have been denied due process. Read the rest of this entry »

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Posted in Lien Resolution, Medicare | 1 Comment »

How Health Care Reform May Affect Settlements

Wednesday, March 31st, 2010

On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act of 2010 into law.  The enactment of this law heralds a new era in American health care and insurance practices.  Though there are many conflicting views on the changes that the law creates, there will definitely be a shift in how insurance companies and health care providers operate from now on.  In reviewing the basics of Health Care Reform, there are many aspects that may have an affect on future settlements in cases where an insurance company or provider has made payment.  It will be important in the coming months and years for attorneys to be aware of the status of their client’s insurance eligibility and enrollment, and to continue to remain compliant throughout the case management process.

Based on some of the basic tenents of the Patient Protection and Affordable Care Act of 2010,  here are a few things that the trial bar may see in the future: Read the rest of this entry »

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Ask a Lien Professional – ERISA Subrogation & Reform

Wednesday, March 31st, 2010

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 Read the rest of this entry »

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