blackburn group inc.

March 2012

Updated Information - Workers' Compensation Review Contractor Bid Protest Now Denied by the GAO on February 27, 2012

As you may recall in our February 2012 newsletter and our recent Latest News website posting, the Centers for Medicare and Medicaid Services (CMS) reported that they had provided a new Workers' Compensation Review Contractor (WCRC) award to Provider Resources, Inc. of Erie, Pennsylvania. Subsequently, the current contractor, Data and Analytic Solutions, Inc., filed a bid protest on July 5, 2011 that was dismissed on August 3, 2011. In response to the dismissal, Data and Analytic Solutions, Inc. filed a second bid protest on November 23, 2011 to overturn the CMS award. The Government Accountability Office (GAO) has now made their decision on the second bid protest and denied their request. The WCRC is the only national reviewer of Workers' Compensation Medicare Set Aside WCMSA proposals in the country for CMS.

CMS Publishes Town Hall MMSEA Section 111 Teleconference Events for Policy and Technical Questions – February through June, 2012

On February 8, 2012, CMS posted the schedule of Town Hall Teleconferences through June of 2012. These calls will address both policy and technical questions you may have regarding Section 111 reporting. Policy discussions will focus on CMS policy supporting the Section 111 NGHP reporting requirements, and how policy is being translated into procedures. Technical support questions will focus on EDI connectivity and data transmission, use of the COB Secure Website, disposition and error codes, and other aspects of the data exchange process. Both CMS staff and representatives of the CMS COBC EDI Department will be available throughout each call.

Medicare Secondary Payer Recovery Contractor – Insurer Liability Demand Letter

Did you know that the Insurer (or Self-Insurer) letter is generally sent out by Medicare Secondary Payer Recovery Contractor (MSPRC) to formally advise the debtor of the amount due back to Medicare in reimbursement of conditional payments? Medicare identifies in this letter the responsible primary payer (Insurer) for services Medicare paid "conditionally" as a result of the accident/incident which occurred. The Statutory Medicare Secondary Payer (MSP) provisions preclude Medicare from paying for a beneficiary's medical expenses when payment has been made, or can reasonably be expected to be made under a workmen's compensation or liability insurance policy or plan (including a self-insured plan). When Medicare is the Secondary Payer for all Workers Compensation or Liability claims, always be sure you have the appropriate Conditional Payment and Final Demand Letters. Being proactive and making the most prudent decisions can make the difference between being compliant under the law versus being faced with any potential fines, interest, and penalties.

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