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 …
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 …
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 …
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 …
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 …
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 …
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 …
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 …
