Congratulations to Nicole Graci on a significant win for our client!

Nicole successfully appealed a Medicare conditional payment demand associated with a 2013 workers’ compensation claim, resulting in a Fully Favorable Redetermination Decision from CMS and over $129,000 savings for our client.

The appeal demonstrated that the claimed conditional payments were unrelated to the original workplace injury. Nicole highlighted a six-year gap in treatment, subsequent work-related accident involving overlapping body parts, and challenged numerous diagnoses as inconsistent with those of the WC claim and stemming from unrelated medical conditions.

Through a detailed analysis of the medical records, workers’ compensation decisions, and Medicare Secondary Payer statute and regulations, Nicole secured elimination of the claimed reimbursement and achieved an excellent result for our client.

If you have any Medicare Compliance needs, such as WCMSA, non-submit MSA, conditional payments, or Medicare Advantage Plan liens, do not hesitate to reach out to Nicole Graci and the Hamberger & Weiss Medicare Compliance Team. Nicole can be reached at ngraci@hwcomp.com.

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