Hear what our attorneys are saying

03
Feb 2021

Answers by Amy

By Amy Bilton     

  QUESTION: Why would I do a Medicare Set-Aside when an individual has an alternative form of health insurance, whether that be through group health insurance after the age of 65 while working for the respondent-employer or through a spouse? It is important to look at the big picture.  Medicare is an entitlement program that
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03
Feb 2021

Surgery and the MSA – How to Exclude it, Hopefully

By William Delaney     

  One of the challenging tasks for MSA allocators is persuading CMS to exclude a surgical allocation when a future surgical procedure is mentioned in the medical record. Although the facts and circumstances of each case differ, three MSA allocations approved by CMS in 2020 provide guidance. As stated in §9.4.3 of the CMS Workers’
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03
Feb 2021

Updated WCMSA Reference Guide Provides Insight into Surgery Pricing

By Joseph Gregorio     

  On October 5, 2020, CMS released version 3.2 of its Workers’ Compensation Medicare Set-Aside (WCMSA) Reference Guide.  One of the changes provided further guidance on how the Workers’ Compensation Review Center (WCRC) prices surgical procedures in WCMSAs.  This is a welcomed step toward greater transparency in pricing of surgical procedures in CMS-approved WCMSAs.  We
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03
Feb 2021

Medicare Part C & D Conditional Payments Update: Enactment of the Provide Accurate Information Directly (PAID) Act

By William Delaney     

  Medicare coverage is not limited to Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). Medicare Advantage Plans (Part C) are also an available option for Medicare beneficiaries. https://www.medicare.gov/what-medicare-covers/your-medicare-coverage-choices  Part C Plans have significantly increased in popularity in recent years. Currently, as least one third of all Medicare beneficiaries are enrolled in a
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13
Jan 2021

COVID-19 Update: Benefits Extended to Essential Workers under House Bill 4276, Passed Today

By Lisa Azoory-Keller     

  In the words of Ralph Waldo Emerson, every sunset brings the promise of a new dawn.  For first responders and front-line workers affected by COVID-19, the sunset provision of House Bill 4276 extends the promises and benefits of the COVID presumptive laws from December 31, 2020 to June 30, 2021.  The bill was passed
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