Axiom National LLC

02/11/2020

If you have 60 seconds, please consider writing and sending a Valentine's Day card to a child receiving treatment at St. Jude Children's Research Hospital.

Choose a sweet e-card featuring layouts inspired by patient art, and then select a pre-written message, or create your own!

02/04/2020

Recently had the pleasure of sponsoring and attending the FASI ( Florida Association of Self Insureds) Winter Meeting in Jacksonville. I really enjoyed the thought-provoking presentations and presenters.

01/23/2020

CMS finalizes decision to cover Acupuncture for chronic low back pain for Medicare beneficiaries. Medicare will cover 12 visits in 90 days.

Use this page to view details for the decision Memo for Acupuncture for Chronic Low Back Pain (CAG-00452N).

01/15/2020

If you are not getting the results you want and expect from your current Medicare Set Aside vendor, please call me at 888-826-6496 or visit our website at www.axiomnational.com
When it comes to Medicare Compliance, accuracy matters.

01/14/2020

Oklahoma Attorney General Mike Hunter files lawsuit against opioid distributors

JAN 14, 2020 - Oklahoma Attorney General Mike Hunter filed a state lawsuit against three major opioid distributors Monday, accusing them of helping fuel the state's deadly opioid crisis by oversupplying the state with the highly addictive painkillers. Named as defendants in the lawsuit are Cardinal....

02/27/2019

CMS Expanded WCMSA Re-review Process

So what do you do if you disagree with a decision from the Centers for Medicare & Medicaid Services (CMS) on a Workers’ Compensation Medicare Set Aside approval amount, or if the claimants treatment/Rx regimen has changed significantly since the original CMS approval of the WCMSA? Historically, parties to a settlement have always been able to submit a Reconsideration or Re-Review request. There are 2 scenarios where this is permitted:

• Mathematical Error: if the CMS decision/approval contains obvious mathematical mistakes OR

• Missing Documentation: if we have additional “evidence” not previously considered by CMS which was dated prior to the submission date of the original proposal which warrants a change in the proposal.

Expanded WCMSA Re-Review:

It has been about a year now since CMS really took a huge leap forward by expanding their Re-Review process. Parties to a settlement now have the ability to submit medical documentation that post-dates the original CMS approval – so long as it results in a 10% or $10,000 change in the allocation.

Originally set forth in V 2.7 of the WCMSA Reference Guide dated March 19, 2018 (and reiterated in subsequent versions), “where the following criteria are met CMS will allow a one time request for re-review in the form of a submission of a new cover letter, all medical documentation related to the settling injury/body part since the previous submission date, the most recent 6 months of pharmacy records, a consent to release information and a summary of expected future care.”

• CMS has issued an approval at least 12 but no more than 48 months prior

• The case has not settled as of the date of the Amended Review request

• Projected care has changed such that the new proposed amount would result in a 10% or $10,000 change (whichever is greater) in CMS’ previously approved amount

• Must attach medical documentation that supports the MSA proposal resulting in the 10%/$10,000 change (this is the one instance wherein CMS will review/consider medical or legal documentation that post-dates CMS’ original allocation determination)

CMS has opened the door to a “2nd bite at the apple”. Not availing yourself to this new process may mean fewer settlements or potentially funding over-inflated WCMSA’s – negatively impacting your bottom line.

Contact Axiom National today to see how we can help you achieve successful claim resolutions!

02/05/2019

As we celebrate our 10 Year Anniversary this month, the staff at Axiom National wishes to convey our most sincere gratitude to our valued clients and partners who have entrusted us to provide solutions to their Medicare compliance needs. Without your loyal support, we would not have achieved this tremendous milestone! Thank you for your continued patronage and we look forward to many more years of delivering exceptional customer service and helping our clients achieve successful claim outcomes.

P.S.
Not sure who we are or what we have done these past 10 years?
Curious to find out?
Visit our website at www.axiomnational.com to discover the services we provide, Case Studies, client testimonials and more.
https://www.axiomnational.com

12/18/2018

Warmest thoughts and best wishes for a wonderful Holiday Season and a very Happy New Year! All of us at Axiom National are very grateful for your business and partnership.
Happy Holidays!

03/27/2018

http://www.tampabay.com/florida-house-passes-bill-for-first-responder-ptsd-benefits-ap_floridac75dddd2bee54213a65f366472b7a8d0

Florida lawmakers have passed a bill extending first responders' workers' compensation benefits to include treatment for post-traumatic stress disorder

03/02/2017

03/01/2016

As you may have heard, there have been significant changes that have taken place with regard to conditional payment recovery efforts by the the Centers for Medicare and Medicaid Services (CMS). We are all aware that this important aspect of Medicare Secondary Payer Compliance may result in penalties or litigation if conditional payments are not properly addressed by reimbursement or dispute.

In October 2015, CMS created the Commercial Repayment Center (CRC), a contingency fee based private subcontractor of CMS, to pursue recovery of conditional payments in cases where the Employer/Carrier has been identified as the responsible party via Section 111 MIR Reporting. The CRC will now be pursuing conditional payment recovery in cases where there is ongoing responsibility for medical benefits (ORM). This is a departure from previous CMS policy, which historically pursued recovery for conditional payments at the time of settlement.

For the claim professional, it’s important to know that the CRC will be issuing time-sensitive “Conditional Payment Notices” or CPN’s. The critical task for the insurance carrier or claim administrator will be to review the CPN immediately in order to decide whether to dispute the alleged conditional payments. Please be aware that if the dispute is not filed within 30 days of the date of the CPN, then the CRC will issue a demand for payment.

In addition to mandatory response deadlines, the CRC is also requiring additional documentation in the form of the Proof of Representation/Letter of Authority for vendors who pursue recovery efforts on behalf of the self-insured employer, insurance carrier or third party administrator.

Axiom National is well positioned to assist you by appropriately disputing Conditional Payment Notices. Should you receive a CPN that you wish to dispute, please refer to our office as soon as possible to ensure that the dispute is filed in a timely manner.

For questions or additional information please contact Geoffrey Hudson at 1-888-826-6496, or [email protected].