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Monday, August 17, 2009

AAJ Comments that Medicare Set-Asides Only Recommend

The American Association for Justice issued a statementt that Medicare Set Aside Agreements were only "recommended" by CMS in workers' compensation claims. In interpreting the reporting requirements of Section 111 Medicare, Medicaid & SCHIP Act of 2007 (MMSEA), Public Law No. 110-173, AAJ declared that there no shift of responsibility that would mandate Set Aside Agreements in liability claims.

For more information on Set Aside Agreements visit the Workers' Compensation Blog.

1 comment:

Teddy Snyder said...

Nothing in the quotes AAJ cites undermines the insurance industry's position. Medicare could always seek reimbursement of a conditional payment from the insurance carrier-- as well as from the plaintiff's attorney! The new reporting law allows Medicare to connect the dots and deny payment for treatment which matches the body part code, diagnostic code and occurrence date of the report.
Any plaintiff's attorney who tells his client that an allocation, i.e., set-aside, is unnecessary puts the client at risk for loss of Medicare benefits, and possibly is putting his/her own E&O insurance on the line.