The Medicare Compliance Blog

Gould & Lamb's team of Medicare Compliance blogging experts share the latest compliance industry news about Medicare compliance reporting.

US Court of Appeals Provides Opinion on Michigan Spine and Brain Surgeons v. State Farm

court building The United States Court of Appeals for the Sixth Circuit published its opinion in Michigan Spine and Brain Surgeons, PLLC v. State Farm Mutual Automobile Insurance Company on July 16, 2014. The long awaited decision addresses the Circuit’s view regarding the Medicare Secondary Payer (MSP) Act’s private cause of action provision. At its core, the parties asked...

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CMS Amends the Workers Compensation Reference Guide

Legal Building On May 29, 2014, the Centers for Medicare and Medicaid Services (CMS) amended the recently released Workers’ Compensation Reference Guide published in February 2014. The changes affect medical review, treating physician reports, pharmacy records and Merit Orders, among others. Section 4.1.4, “Hearing on the Merits of a Case,” is particularly noteworthy. With the publishing of the February Guide, no language specifically addressed evidentiary orders from the finder of fact. Presumably, and based upon longstanding CMS and WCRC procedure, evidentiary orders were...

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Workers Compensation Review Center (WCRC) Changes Position on Development Letters

Legal Building As a result of Gould and Lamb’s continued advocacy with CMS Central Office, WCRC, and Regional Offices, Workers’ Compensation Medicare Set Aside submitters will see a light at the end of the tunnel. Based on direct conversations, we anticipate a turn-around in what has been an arduous approval process with repeated development requests that were neither germane nor reasonable. The WCRC is starting...

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Self Administration Toolkit for WCMSAs

Referral Forms Centers for Medicare and Medicaid Services added a Self Administration Toolkit for Workers’ Compensation Medicare Set-Aside Arrangements on April 11

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House Passes Measure to Delay ICD-10 Transition

Rayburn Building DC By voice vote on Thursday, March 27, the House approved another temporary (one-year) fix to prevent steep cuts in Medicare’s physician reimbursement scheduled to take effect March 31. It now moves to the Senate which is expected to take action within the next few days. The draft legislation does not address the problems with the Workers' Compensation Medicare Set-Aside approval process. However, there is language that speaks to

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