Reading Room

CMS Will No Longer Allow Administrative Costs to Be Charged To The Set-Aside Arrangement

Jon 6777

CMS issued a memorandum on prohibiting costs to be chargeable against Medicare set-aside arrangement funds.The purpose of this All Regional Administrators memorandum is to replace the policy that was outlined in the answers to questions in the All Associate Regional Administrators (ARA) memorandum concerning Workers’ Compensation Commutation of Future Benefits (issued on July 23, 2001, attached) and in the answer to question seven from the April 21, 2003 Frequently Asked Questions (FAQ).

CMS Will No Longer Allow Administrative Costs to Be Charged To The Set-Aside Arrangement

Jon 6780

CMS issued a memorandum on prohibiting costs to be chargeable against Medicare set-aside arrangement funds.The purpose of this All Regional Administrators memorandum is to replace the policy that was outlined in the answers to questions in the All Associate Regional Administrators (ARA) memorandum concerning Workers’ Compensation Commutation of Future Benefits (issued on July 23, 2001, attached) and in the answer to question seven from the April 21, 2003 Frequently Asked Questions (FAQ).

Workers' Compensation News - June 9, 2004 Volume 2 Issue 23 CompAssist (tm)

Jon 9884

 MEDICAL GUIDELINES IN WC CASES APPROVED BY TEXAS SP CT. "In this opinion, we conclude that the Legislature authorized TWCC to set upper limits on reimbursement amounts and establish a reasonable time limitation on requests for medical dispute resolution. TWCC acted consistently with the Legislature’s mandates - (1) the establishment of fair and reasonable guidelines designed to ensure quality medical care for injured workers, TEX. LAB. CODE § 413.011(b), (2) the achievement of effective medical cost control in the workers’ compensation system, id., and (3) the establishment of a program for resolution of disputes regarding health care treatments and services, id. § 413.013(1). "

Texas Workers' Compensation Commission v. Patient Advocates of Texas, et al, Decided May 28, 2004.

Workers' Compensation News - June 9, 2004 Volume 2 Issue 23 CompAssist (tm)

Jon 9884

 MEDICAL GUIDELINES IN WC CASES APPROVED BY TEXAS SP CT. "In this opinion, we conclude that the Legislature authorized TWCC to set upper limits on reimbursement amounts and establish a reasonable time limitation on requests for medical dispute resolution. TWCC acted consistently with the Legislature’s mandates - (1) the establishment of fair and reasonable guidelines designed to ensure quality medical care for injured workers, TEX. LAB. CODE § 413.011(b), (2) the achievement of effective medical cost control in the workers’ compensation system, id., and (3) the establishment of a program for resolution of disputes regarding health care treatments and services, id. § 413.013(1). "

Texas Workers' Compensation Commission v. Patient Advocates of Texas, et al, Decided May 28, 2004.

CMS Entering Into Data Sharing Agreements

Jon 7287

 The Health Insurance Portability and Accountability Act includes a provision establishing the Medicare Integrity Program (MIP). This provision gives the Centers for Medicare & Medicaid Services (CMS) authority to enter into contracts with entities to promote the integrity of the Medicare program. The MIP includes a range of Medicare program areas such as cost report auditing, medical review, anti-fraud activities, and the Medicare Secondary Payer (MSP) program. 

CMS Entering Into Data Sharing Agreements

Jon 7294

 The Health Insurance Portability and Accountability Act includes a provision establishing the Medicare Integrity Program (MIP). This provision gives the Centers for Medicare & Medicaid Services (CMS) authority to enter into contracts with entities to promote the integrity of the Medicare program. The MIP includes a range of Medicare program areas such as cost report auditing, medical review, anti-fraud activities, and the Medicare Secondary Payer (MSP) program. 

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