The Medicare Secondary Payer Act provides that Medicare is a Secondary Payer when a primary payer has responsibility for payment.

You may have asked that question lately. In the management of workers’ compensation claims, Utilization Review (UR) provides a process whereby proposed treatment is assessed for medical necessity and reasonableness.

As we move further away from 9/11, it is apparent that the list of health conditions related to the toxic chemical exposures at the devastation sites is growing.

Lyrica has been the subject of recent discussions within the Medicare Set-Aside professional community.

I have a claimant who is currently 62 years and 1 month old.  The total settlement is over $250,000.   Does this meet the CMS review threshold? If not, are we “safe” by not submitting?

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.

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.

Two recent decisions of the Court both have an impact on how an employer manages its business and engages with its employees.

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 diminished credibility.

Welcome to the Summer 2018 edition of the Medicare Secondary Payer Compliance Corner.