Maintaining Status Quo: CMS Retains $750 TPOC and Recovery Threshold

True to form, the Centers for Medicare & Medicaid Services (CMS) released another Alert during a holiday weekend.  This time, on the day before Thanksgiving Day, CMS announced that the Total Payment Obligation to the Claimant (TPOC) and Conditional Payment recovery thresholds for Workers’ Compensation, Liability, and No-Fault insurance claims remain unchanged at $750.  These… Read more »

Ask Annie: Complex Settlements, Simplified

Question: We are settling a complicated claim involving a claimant’s lower back. Over the course of the claimant’s workers’ compensation claim they added a number of additional dates of injury (DOI) that involved no additional treatment, but each of these has its own claim number and we are hoping to resolve the entire matter in… Read more »

Ask Annie: When can I safely terminate ORM?

Today’s question implicates Medicare’s mandatory insurer reporting requirements. Identifying and understanding how to fulfill these obligations is an important element to claims handling, made critical by the proposed regulations outlining whether and how Medicare may penalize noncompliant entities.

MSA Alert: Updated Consent to Release Language Required This Week

As of April 1, 2020, Medicare Set-Aside (MSA) submissions must include an updated Consent to Release (CTR) form containing additional language indicating the claimant had the MSA process explained and the claimant approves of the contents of the MSA proposal.

Ask Annie: Mythical Zero Allocations

A “zero allocation” is what we call not setting money aside to pay for a claimant’s post-settlement Medicare-covered medical needs. A zero allocation is possible in two situations.