The Official Medicare Set Aside Blog And Information Resource

New announcement regarding Hydrocodone combination product coverage changes in Medicare Part D effective for WCMSA proposals

CMS, Medicare Set-Aside Blog, Rx/Pharmacy on November 19, 2014 | Posted by Jean S. Goldstein, JD

On November 19, CMS issued an alert regarding a CMS trend we have been seeing more frequently as related to more frequent physician visits.  The alert specifically refers to action taken by the U.S. Drug Enforcement Administration regarding rescheduling of hydrocodone combination products from C-III controlled substances to C-II controlled substances.  Based on this classification, […] Continue

What’s Good for the Goose… MSAs the Federal Government’s Way

Commentary, Medicare Set-Aside Blog, Medicare Set-Asides, MSP Litigation on November 17, 2014 | Posted by Jennifer Jordan, JD, MSCC

An interesting longshore case involving an MSA was recently reported out of Oregon. Claimant Phillip Tucker was hurt on a vessel owned by the United States and being serviced at Cascade General, Inc., the plaintiff’s employer. Tucker filed suit against both and then each of them filed cross-claims against each other. Tucker’s wife had filed […] Continue

MMSEA Section 111 Alert: CMS to Allow NGHP RREs to Designate a Medicare Secondary Payer Recovery Agent through Mandatory Insurer Reporting, July 2015

CMS, Medicare Set-Aside Blog, MSP News on November 14, 2014 | Posted by Jessica M. Wingenroth, JD

The current “TPA workaround” method of identifying a third party administrator on TIN Reference files is being eliminated. CMS has announced that effective 07/13/15, NGHP RREs will have the option to designate an MSP Recovery Agent with whom they wish to share copies of all correspondence related to conditional payments and recovery demands. The RRE […] Continue

Visit MEDVAL Next Month at the National Workers’ Compensation and Disability Conference (NWCDC) in Las Vegas

Medicare Set-Aside Blog, MEDVAL News, MSP News, News and Events on October 29, 2014 | Posted by Jon Gunter, CMSP

The NWCDC is rapidly approaching!   November 19-21, 2014, marks the 23rd anniversary of this event which is to be held at the Mandalay Bay Convention Center for the second straight year.    For more details visit the conference website here: www.wcconference.com Jennifer Jordan will be moderating a session titled “Workers’ Compensation and Its Secondary Payers:  Medicare […] Continue

NGHP Mandatory Insurer Reporting Technical Alert: CMS to Eliminate Seconds and Centiseconds from Time Stamp on Response Files

CMS, Medicare Set-Aside Blog, News and Events on October 29, 2014 | Posted by Jessica M. Wingenroth, JD

CMS is tweaking the naming conventions for Claim Response, TIN Response and Query Response files. For each Claim Input, TIN Reference and Query Input file an RRE submits, the BCRC produces a corresponding response file. When the BCRC generates a response file, the file name contains a date and timestamp. Effective 04/06/15, the time stamp […] Continue

When MSA Surgery Occurs Between Settlement and State WC Approval

CMS, Commentary, Medicare Set-Aside Blog, Medicare Set-Asides, MSP Litigation on October 29, 2014 | Posted by Jennifer Jordan, JD, MSCC

One of the frustrating things about waiting for CMS approval is watching a carrier pay for ongoing medical expenses that are included in the proposed MSA and then fully fund the MSA once approved. Because of the method CMS uses to calculate MSAs, the current full calendar year is always included unless the claimant is […] Continue

Section 111 NGHP User Guide Version 4.3, Revised to Implement Eight Change Requests, Primarily Related to ICD-10 Coding

Medicare Set-Aside Blog, MSP News on October 9, 2014 | Posted by Jessica M. Wingenroth, JD

According to the Revision History, Version 4.3 of the NGHP User Guide applies more changes than any other update in the 5+ years since Version 1.0 was published.  A majority of the changes are associated with ICD-10 coding, which will be required when RREs are reporting dates of incidents occurring as of 10/01/15. ICD-10-related revisions […] Continue

MSA Surgery Mystery Solved

Commentary, Medicare Set-Aside Blog, MSP Litigation on September 26, 2014 | Posted by Jennifer Jordan, JD, MSCC

      After years of reviewing medical records and surgery pricing, I could never figure out what made surgical screws so expensive. Those screws look a lot like the ones we get bags full of at IKEA with any piece of furniture and I can furnish an entire room with what one pedicle screw […] Continue

Update: Upcoming Enhancement to the WCMSAP for Prescription Drug Information Rolling Out On October 6, 2014

CMS, Medicare Set-Aside Blog, MSP News, News and Events on September 23, 2014 | Posted by Louis

CMS issued an alert last month indicating that a new enhancement to the WCMSA portal for prescription drug treatment would be forthcoming.   Yesterday, CMS issued an additional alert confirming that this new feature will be available as of October 6, 2014.  A new training document, with images, showing the upcoming enhancement to the portal is […] Continue

NGHP Mandatory Insurer Reporting Alert: Final Five Digits of SSN is the New Minimum Requirement for Reporting, Effective 01/05/2015

CMS, Medicare Set-Aside Blog, MSP News, News and Events on September 16, 2014 | Posted by Jessica M. Wingenroth, JD

CMS has issued an Alert that effective 01/05/15, if an individual’s HICN or full SSN cannot be obtained, reporting can still occur as long as the individual’s last five digits of SSN, first and last name, date of birth and gender are produced. Nevertheless, reporting with a HICN or full SSN continues to be highly […] Continue