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.

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.

CMS will consider a proposed Medicare Set-Aside (MSA) when the Total Settlement Amount (TSA) exceeds the one of two review thresholds.

The Medicare Secondary Payer (MSP) Act provides that Medicare will make conditional payments for medical services when a primary plan has not made, or cannot reasonably be expected to make, payments for those services.

By now, most claims adjusters and attorneys involved in workers’ compensation and liability settlements are aware of the Medicare Secondary Payer Act (MSP Act) and the potential impact that it may have in certain settlements.