Investigative Report Raises Issues

The tension between public pension systems and workers' compensation programs was highlighted in a recent investigative report by the NJ State Comptroller. The report raises additional critical issues common to other state and national collateral social insurance programs challenged by current fiscal limitations.

Halting Workplace COVID-19 Transmission: An Urgent Proposal to Protect American Workers

A report authored by David Michaels and Gregory R Wagner and published by The Century Foundation highlights the actions needed to strengthen The Occupational Safety and Health Administration {OSHA] in order to make workplaces safer. Today’s post is shared from tif.og

CMS is Hosting A Webinar on Insurance Plan Appeals

Commercial Repayment Center (CRC) Non-Group Health Plan (NGHP) Applicable Plan Recovery Webinar: Appeals Thursday, September 24, 2020 1:00pm ET

CMS Cannot Seek Reimbursement from Insurance Guarantee Fund

The US 9th Circuit Court of Appeals has ruled that The Centers for Medicare and Medicaid [CMS] cannot not seek reimbursement from from the California Insurance Guarantee Association for workers' compensation payments.

CMS has scheduled another webinar for Wed., Sept 19, 2018

Commercial Repayment Center Portal (CRCP) Overview Webinar Wednesday, September 19 th, 2018 CMS will be hosting a webinar to present an overview of the Commercial Repayment Center Portal (CRCP) functions.

NJ Will Not Adopt the IAIABC Model Rule on Electronic Billing

The NJ Department of Labor and Workplace Development [DLWD] has adopted Rules regarding electronic medical billing in workers' compensation matter that do not follow the International Association of Industrial Accident Boards and Commission's [IAIABC] Model Rule. The NJ DLWD has decided to accept the ASC X12 837 [ASC] standard only.

Medical Fees: Does One Price Fit All?

The Federal government has proposed a simplified medical billing process that may impact workers' compensation billing practices going forward. Most workers' compensation fee medical fee schedules are linked either directly and indirectly the to Federal Medicare model and a proposed Rule published last week in the Federal Register proposes a single fee for all office visits.

NJ Mandates Reporting of Medicare Conditional Payments

The NJ Division of Workers’ Compensation has now mandated the reporting of pending workers’ compensation claims possibly eligible for reimbursement of conditional medical payments to the US Centers for Medicare and Medicare Services  (CMS) as a condition precedent to the settlement of a pending claim for benefits.  The directive was outlined in a memorandum issued by Russell Wojtenko, Jr., Director and Chief Judge of Compensation on April 18, 2018.

Just Published: 2018 Update - Gelman on Workers' Compensation Law

Jon Gelman’s newly revised and updated 2018 treatise on Workers’ Compensation Law is now available from by West Group of Egan, MN within the next few weeks. The treatise is the most complete work available on NJ Workers’ Compensation law and integrated with WESTLAW™, the "most preferred online legal research service.'"

CMS to Host Webinar: Commercial Repayment Center Contractor Transition

Commercial Repayment Center Contractor Transition Webinar for Non-Group Health Plans on Thursday, January 18, 2018 

Effective February 8, 2018, a new contractor will assume the responsibility of the Medicare Commercial Repayment Center (CRC) functions.

Guidelines for Medical Provider Claims - A Valuable Approach

While the vast majority of jurisdictions in the US have the guidance of mandatory workers' compensation medical fee schedules, New Jersey remains one of the very few with no such structure. As I reported earlier, this generates multiple issues in the claims process and creates costly delays in the adjudication of disputes.

Governor of Nevada Vetoes Single-Payer Legislation

Nevada Governor Brian Sandoval has vetoed legislation that would have established a single-payer Assembly Bill 374 would have expanded a Medicare-type health care insurance plan. coverage to provide health care coverage to all Nevada residents.

Chaos for Workers' Compensation Programs--The Elimination of Social Security Numbers?

The Centers for Medicare & Medicaid Services (CMS) is readying a fraud prevention initiative that removes Social Security Numbers (SSN) from Medicare cards to help combat identity theft and safeguard taxpayer dollars. The question remains whether the elimination will cause chaos in state workers' compensation programs since the SSNs have historically been utilized as personal identifiers.

CMS Prohibited From Collecting for Unrelated Conditions

A Federal Court in California has prohibited the Center for Medicare and Medicaid Services (CMS) from seeking reimbursement of conditional payments when the medical codes for the conditions are unrelated or not related even if the primary code was for a work-related medical condition. The court made the following ruling in a motion for partial summary judgment in a declaratory judgment action.

The limits on a total permanent disability award

The New Jersey Supreme Court recently heard oral argument concerning the mathematical limits of a workers’ compensation total disability case. At the heart of the case is the issue of whether an injured worker could have an increase in a pre-existing permanent partial disability [PPT] claim, that existed prior to the last compensable injury which was to another part of the body. The last compensable claim rendered the worker totally and permanently disabled.

The Promise of State Initiatives to Prevent Long Term Work Disability

Every year, millions of Americans suffer from medical conditions that affect their ability to work. This puts them at risk of losing their jobs or being forced to rely on Social Security Disability Insurance (SSDI). States could help many of these workers stay in their jobs, but promising options for doing this remain largely untested. The five states with state-mandated short-term disability benefits— California, Hawaii, New Jersey, New York, and Rhode Island—are promising settings for such tests.

Judge Accepts Medicare’s Plan To Remedy Misunderstanding On Therapy Coverage

Today's post is shared from Kaiser Health News khn.org

"A federal judge has accepted Medicare’s plans to try once more to correct a commonly held misconception that beneficiaries’ are eligible for coverage for physical and occupational therapy and other skilled care only if their health is improving.

"'Confusion over the Improvement Standard persists,' wrote U.S. District Court Chief Judge Christina Reiss in Vermont in a decision released by the court Thursday. Advocates for seniors say coverage is often mistakenly denied simply because the beneficiary reaches “a plateau” and is no longer making progress.

CMS Town Hall Conference - Coordination of Benefits & Recovery for Liability Insurance (including Self-Insurance), NoFault Insurance and Workers’ Compensation

Town Hall Teleconference– November 17, 2016 
Coordination of Benefits & Recovery for Liability Insurance (including Self-Insurance), NoFault Insurance and Workers’ Compensation

On November 17, 2016, CMS will host a teleconference to connect with stakeholders and provide status updates. CMS expects to discuss the following topics:

• Ongoing Responsibility for Medicals (ORM) recovery, 
• Final Conditional Payment (CP) process reminders, 
• Medicare Secondary Payer Recovery Portal (MSPRP) improvements.

US Department of Labor Urges Major Changes in the Nation's Workers' Compensation System

As The Path to Federalization of the US workers' compensation system broadens, the US Department of Labor has published a report urging expansion of the Federal role in reforming the entire patchwork of state systems. As the Presidential Election Cycle moves ahead, the ultimate outcome will impact the the nation's struggling workers' compensation scheme. Based on historical statements both "Hillarycare" or "Trump Medical," (lead by his advisor, Former Speaker Newt Gingrich,  will focus on this issue. See  my prior blog posts below.

CMS 2016 Recovery Thresholds for Workers’ Compensation Settlements, Judgments, Awards or Other Payments

2016 Recovery Thresholds for Certain Liability Insurance, No-Fault Insurance, and Workers’ Compensation Settlements, Judgments, Awards or Other Payments 

As required by section 1862(b) of the Social Security Act, the Centers for Medicare and Medicaid Services (CMS) has reviewed the costs related to collecting Medicare’s conditional payments and compared this to recovery amounts.