Legal News

MEDICARE NEWSFLASH For several years we have been advising our clients, all of whom are in the Ninth Circuit (California, Arizona, Nevada, Washington, Montana, Oregon, Hawaii, Idaho and Alaska), that Federal Circuit Court cases throughout the country have shown a continuing increase in jurisdictions adopting the reasoning of the In Re Avandia case, which holds that Medicare Advantage Plans (MAPs – also …

REMOVING SOCIAL SECURITY NUMBERS TO PREVENT IDENTITY THEFT The Centers for Medicare and Medicaid Services has just confirmed Medicare ID cards will remove Social Security numbers in 2018 as part of the agency’s continuing effort to increase beneficiary privacy protections. Medicare is preparing to stop using Social Security numbers for identification next year and will send new cards to patients with …

IMPORTANT NEW MEDICARE REIMBURSEMENT DEVELOPMENT: OPTION TO NOTIFY BCRC THAT A CASE IS APPROACHING SETTLEMENT AND REQUEST FINAL CONDITIONAL PAYMENT PROCESS BEGIN As part of the Strengthening Medicare and Repaying Taxpayers Act of 2012 (the SMART Act), the Medicare Secondary Payer Recovery Portal (MSPRP) has been modified to permit authorized users to notify the Benefits Coordination & Recovery Center (BCRC) …

New Lee v. Silveira case extends Howell analysis, holding that in order to prevail under C.C.P. Section 998, plaintiff can use only the negotiated rate differential in determining whether he/she did “better” than the statutory offer – not the gross amount the jury may have awarded. Be sure to read our other Howell related posts.

CMS has just issued final rules implementing additional KEY PROVISIONS of the Strengthening Medicare and Repaying Taxpayers Act of 2012 (SMART Act).  The Act, which was moved through Congress in record time thanks to the efforts of the Medicare Recovery Advocacy Coalition (MARC) and Roy Franco, has five primary provisions, which CMS has been implementing individually.  Perhaps the most important …

Better, Smarter, Healthier: In historic announcement, HHS sets clear goals and timeline for shifting Medicare reimbursements from volume to value We’ll be updating you on how these goals are met and posting any updates on what this shift means to you for Medicare reimbursements. You can download the Fact Sheet and read the entire release: Fact sheets – Better Care …

Court of Appeal holds that a party’s denials of requests for admissions are inadmissible at trial ,where a party’s conduct in litigation is not in issue. The First District Court of Appeal ruled yesterday that a party’s denial or lack of admission in response to requests for admissions cannot be used for impeachment purposes. The panel overturned a judgment of …

In further implementation of the SMART Act, on January 5th, 2015 CMS released the latest version of the MMSEA Section 111 NGHP User Guide. The changes were expected, and are welcomed. The 2 major changes to the user guide are outlined below: 1) CMS will now accept 5 digit SSN’s on submitted records. RREs that submit query and claim input …

Dear Friends and Colleagues:  The following informative update has been received from a colleague, and I pass it along as it touches on aspects of Medicare and other insurer reimbursement, particularly in the context of charges disputed because they are asserted to be excessive.  Please let me know if you would like to discuss any of these issues further. “Just …

On August 1, 2014, the Centers for Medicare and Medicaid Services (CMS) provided additional information regarding the upcoming change to the ICD-10 coding system which we regularly use in preparing documents, such as notices to COB&R and Releases, for our clients.  If you have wondered why the change is being made, the current ICD-9 coding system has about one-tenth the …

A proposed rule updates payment policies & rates under for patients with End-Stage Renal Disease (ESRD) for services furnished on or after January 1, 2015

The 2015 General Equivalence Mappings (GEMs) and Reimbursement Mappings are now available on the 2015 ICD-10-CM and GEMs web page and 2015 ICD-10-PCS and GEMs web page. These mappings can be used to convert policies from ICD-9-CM to ICD-10 codes. The GEMs provide both forward (ICD-9-CM to ICD-10) and backward (ICD-10 to ICD-9-CM) mappings. For detailed information on these mappings, see …

Defense counsel made a motion in limine to preclude plaintiff from offering expert witness testimony based on the contention that plaintiff’s failure to disclose expert information was unreasonable. The trial court agreed, and that decision was upheld on appeal. The Third District reasoned that while C.C.P. §2034.300 did not mandate exclusion of plaintiff’s expert testimony because the defendant did not timely comply with the disclosure date, there is nothing in C.C.P. §2034.300 that would preclude the court from exercising its discretion to exclude the testimony based on the plaintiff’s “egregious violation” of the exchange requirements.

ICD-10 Compliance, recently set to start on October 1, 2014, has now been PUSHED BAC, by the Protecting Access to Medicare Act of 2014 (PAMA) (Pub. L. No. 113-93), to October 1, 2015.  The Act provides that the Secretary may not adopt ICD-10 prior to October 1, 2015. Accordingly, the U.S. Department of Health and Human Services expects to release …

CMS Issues Proposed Hospital Inpatient Payment Regulation Proposed rule would strengthen tie between payment and quality improvement On April 30, CMS issued a proposed rule that would update FY 2015 Medicare payment policies and rates for inpatient stays at general acute care and long-term care hospitals (LTCHs). This rule builds on the Obama administration’s efforts through the Affordable Care Act to …

On April 1, 2014, President Obama signed into law the Protecting Access to Medicare Act of 2014. This new law prevents a scheduled payment reduction for physicians and other practitioners who treat Medicare patients from taking effect on April 1, 2014.

Video from a seminar entitled Proving the Value of Present and Future Medical Bills under Howell, Corenbaum and Dodd v. Cruz and How to Establish “Negotiated Rate Differentials” in Medicare, Kaiser and other Lien Cases presented by the Association of Defense Counsel of Northern California and Nevada.

Change in Reporting Threshold for Certain Liability Settlements, Judgments Awards, or Other Payments

As required by section 202 of the Strengthening Medicare and Repaying Tax Payers Act of 2012 (SMART Act), the Centers for Medicare & Medicaid Services (CMS) has reviewed the costs related to collecting data and determining the amount of Medicare’s recovery claim and has calculated a revised single threshold for physical trauma-based liability insurance settlements. (Note: This threshold does not apply to settlements for alleged ingestion, implantation or exposure cases.)

Seana Thomas will be lead panelist at an important seminar for all litigators in California, combining her two areas of practice emphasis: litigation and Medicare Secondary Payer Reimbursement. The Seminar, sponsored by the Association of Defense Counsel of Northern California and Nevada will be held in San Francisco, CA, on Friday February 21, 2014. We’ll post updates as they become …

Seana will be speaking at the Vons Annual Defense Panel Conference this year in Arcadia, California. Her discussion will focus on Medicare Secondary Payer reimbursement updates. The event will take place on November 8th, 2013 Seana Thomas is frequently sought for public speaking engagements and expert witness testimony. If you would like to have Seana at your next event, please …

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