Tag Archives: Medicare

Medicare Set-asides – Still Not Required in Liability Cases

The old rules were easily understood. Certain workers comp claims required a Medicare set-aside – and the rules for those claims were straightforward. For other claims – liability and no-fault cases – the parties were still required to satisfy Medicare’s interests out of the settlement.

For years, we’ve been told that Medicare set-asides were coming for no fault and liability cases. You’ve been to the seminars. Some attorneys and insurance companies have probably been telling you for years that this is a requirement.

They’ve been wrong. Until now?

As of October 1, 2017, CMS issued new guidance to the Secondary Payer process: MM9893. Sounds ominous, doesn’t it?

The gist of the rule is that CMS will begin to track whether there is a Liability Medicare Set-aside (LMSA) and if there is, Medicare will stop paying for diagnosis codes that should have been covered by the LMSA. Side note – they didn’t do this before? Why the heck not? I thought that was the point of LMSAs, to the extent that they existed. WTH?

The key point to remember is… that’s it. There is NO REQUIREMENT that an LMSA be set up at all. None. All this says is that if there is one, it has to be used before Medicare will pay again. I’m not just making this up – it’s in the guidance and the rule – ” Liability and NoFault MSP claims that do not have a Medicare Set-Aside Arrangement (MSA) will continue to be processed under current MSP claims processing instructions. ”

There has been no statutory change that requires LMSAs. Remember that when someone inevitably misunderstands this minor change.

Of course, don’t kid yourself – that still might happen someday.

(Howard Zimmerle is an attorney practicing injury law in Iowa and Illinois. You can reach him at 309-794-1660 or hzimmerle [at] qclawyers.com)

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Filed under Legal News, Medicare, Negotiations, Settlements, Uncategorized

Washington Post Article – “Focus on Patient Safety Hasn’t Succeeded”

Here’s an interesting, short article written by a doctor about the continuing problem of preventable errors and preventable deaths in hospitals.

The main point of the article is that too many preventable injuries/deaths are still happening in hospitals and that hospitals need to “build a culture in which patient safety is the priority” for everyone involved.

Very true.

One of the interesting things in the article is a discussion of the continued efforts to prevent hospital-acquired infections – the article states that “nearly all can be eliminated.” The amazing thing is that it has been over 160 years since Semmelweis figured out that doctors should wash their hands in between handling cadavers and delivering babies, yet some methods of preventing infection are still being ironed out. (And as an aside, doctors still don’t always wash their hands).

(Howard Zimmerle is a medical malpractice attorney in Rock Island, Illinois. You can reach him at 309-794-1660 or hzimmerle [at] mjwlaw.com).

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You know those New Medicare Reporting Requirements You Always Hear About? They Have Been Bumped Back to 2012

It’s crazy. Two posts in a row talking about new 2012 requirements that scare the heck out of attorneys. (See the last one here).

This time it’s the big, scary, “new Medicare reporting requirements” that have defense lawyers in a tizzy. As you may recall, as of 2011, liability insurers were supposed to start reporting certain settlements to Medicare – known as TPOC (total payment obligation to claimant) settlements. These reporting requirements have been postponed until 2012. Good!

(Howard Zimmerle is a personal injury, medical malpractice and workers compensation lawyer with offices in Rock Island, Illinois and Davenport, Iowa. You can reach him at 309-794-1660 or hzimmerle [at] mjwlaw.com)

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