Hear what our attorneys are saying

12
Sep 2018

Lyrica: Is It In or Out?

By      Blog

Lyrica has been the subject of recent discussions within the Medicare Set-Aside professional community. Submitters have been surprised to find CMS including Lyrica in WCMSA determinations in situations where it had previously been excluded. Since the Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide (Version 2.7, March 19, 2018) purports to explain the process used
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30
Aug 2018

Introducing “Answers from Amy”

By      Blog

Medicare Secondary Payer compliance is an area of practice that is governed by the MSP Statute and supporting Federal Regulations.  In addition to the law, the Centers for Medicare and Medicaid Services (CMS) also publishes the Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide.   The application of the MSP Statute to a particular set of
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29
Aug 2018

Prioritizing Payments

By      Blog

In yet another ruling concerning Medicare Advantage Organizations’ rights to pursue the private cause of action under the Medicare Secondary Payer Act, a U.S. District Court in Illinois held that assignee-organizations may pursue rights of recovery on behalf of assignor-MAOs with valid assignment agreements. MAO-MSP Recovery II, LLC. v. State Farm Mut. Auto. Ins. Co.,
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22
Aug 2018

“Moneyball” Comes to Claims Handling

By      Blog

Having revolutionized how we look at everything from baseball, elections to meteorology, it was only a matter of time before predictive analytics were utilized to better manage workers’ compensation claims. According to a recent Business Insurance article, Rising Medical Solutions spent five years polling “high performing” claims organizations and found that they utilized predictive analytics
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13
Aug 2018

The Best Way to Find a Job is to Actually Look for One

By      Blog

In an effort to substantiate a claim for permanent total disability or wage differential, a claimant may embark on a self-directed job search, which can result in significant damage to Petitioner’s case.  Self-directed job logs, ledgers and spreadsheets created by a Petitioner should be heavily scrutinized, and can be critical in pointing to a claimant’s
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31
Jul 2018

Crossing the Threshold: What’s included in the Total Settlement Amount?

By      Blog

    CMS will consider a proposed Medicare Set-Aside (MSA) when the Total Settlement Amount (TSA) exceeds the one of two review thresholds. The CMS review thresholds are well-known and, for Medicare beneficiaries, is only $25,000. For claimants who have a reasonable expectation of Medicare enrollment within 30 months of the settlement date, the threshold
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31
Jul 2018

The Lumbar MRI Dilemma

By      Blog

    If you’ve got low back pain, you’re in good company.  Low back pain is the most common musculoskeletal condition in the adult population, with prevalence up to 84%.[1]  The use of advanced imaging (such as MRI) is dramatically on the rise, despite lack of evidence to support its benefit.[2] The fact pattern may
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"The foundation of our longstanding partnership with the firm is based on our shared values of honesty and fairness. They recognize our unique needs and work with us to achieve a desired outcome in a cost efficient and practical manner."

-Larry Collins, Senior Director, Risk Management Marriott Claims Services, Chicago

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