The Official Medicare Set Aside Blog And Information Resource

WCRC RFP Due Date Revised, Again.

CMS, Medicare Set-Aside Blog, Medicare Set-Asides on February 10, 2017 | Posted by Jean S. Goldstein, JD

CMS just issued an additional amendment to the RFP for the WCMSA review contractor. The amendment published additional responses to questions by offerors, and also a change in the due date for proposals to 10:00 am February 15, 2017. The amendment to the solicitation can be found here. Stay tuned for more details. Continue

California Proposition 64, and Other Marijuana Legislation: Are These Legislative Actions the Gateway to Marijuana Inclusion in Medicare-Set Asides?…Not Likely.

Medical Marijuana, Medicare Set-Aside Blog on February 6, 2017 | Posted by Jean S. Goldstein, JD

In 1996, California became the first state to allow for medical use of marijuana.  Marijuana is and remains classified as a Schedule I drug, which is defined by the United States Drug Enforcement Agency as, “substances with no currently accepted medical use and a high potential for abuse.”  Schedule I drugs also include drugs, such […] Continue

WCRC RFP Due Date Revised

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News on January 20, 2017 | Posted by Jean S. Goldstein, JD

Yesterday, CMS issued an amendment to the RFP for the WCMSA review contractor. The amendment published responses to questions by offerors, and informed offerors that additional answers to questions will be released on January 25, 2017. The amendment also reflects a change in the due date for proposals, to 10:00 am February 8, 2017. The […] Continue

Arymo ER – Latest Addition to the Abuse Deterrent Opioids Market

FDA, Medicare Set-Aside Blog, Rx/Pharmacy on January 19, 2017 | Posted by Abidemi Oyebode, R.Ph., MBA - Clinical Pharmacist

Last week, the FDA approved Arymo ER, an abuse-deterrent formulation of morphine sulfate extended release tablets, marketed by Egalet Corporation. Arymo ER comes in three dosage strengths: 15mg, 30mg, and 60mg and slated to hit the market first quarter 2017.  Arymo ER is the latest addition to the growing list of abuse-deterrent opiates like Troxyca […] Continue

MSP False Claims Action Reaching Its Conclusion

Medicare Set-Aside Blog, MSP Litigation, MSP News on January 18, 2017 | Posted by Jennifer Jordan, JD, MSCC

On January 18, 2017, the Second Circuit Court of Appeals brought an end to Kent Takemoto’s dreams of whistle blower riches. The Court upheld the District Court’s adoption of the Magistrate’s recommendation to dismiss the false claims action, finding that he failed to plead facts as to each defendant’s obligation to repay the government. Although […] Continue

150 Million Medicare Health Insurance Claim Numbers to be Changed to New Medicare Beneficiary Identifier Numbers in 2018

CMS, Medicare Set-Aside Blog, MSP News on January 18, 2017 | Posted by Katharine Rupp, JD

On Tuesday January 17, 2017, CMS held a special open door forum to discuss the changes and impact of the SSNRI on Medicare Secondary Payer (MSP) stakeholders. Starting April 1st, 2018, CMS will be replacing all Social Security Number (SSN) based Health Insurance Claim Numbers (HICN) with Medicare Beneficiary Identifier (MBI) numbers. Over 150 million […] Continue

Inclusion of CT Scans Instead of MRI Scans in WCMSAs for Claimants with Intrathecal Pumps

FDA, Medicare Set-Aside Blog, Medicare Set-Asides on January 12, 2017 | Posted by Erin O'Neill, PA-C, JD

It is commonplace for CT scans to be included in WCMSAs, in lieu of MRI scans, for Claimants with implanted intrathecal pumps; however, little thought is given to the reason for this substitution. Intrathecal pumps are small implanted programmable battery powered devices that dispense medication which is carried directly to the spinal cord by a […] Continue

CIGA Wins Partial Summary Judgment on Issue of Over-inclusive Reimbursements

Conditional Payments, Jen Article, Medicare Set-Aside Blog, MSP Litigation on January 9, 2017 | Posted by Jennifer Jordan, JD, MSCC

On January 5, 2017, the U.S. District Court for the Central District of California ruled in favor of the California Insurance Guarantee Association (CIGA) in its ongoing challenges against CMS over its MSP practices. After several years and many amended complaints, the only remaining issue in this litigation was CIGA’s allegations that CMS calculates its […] Continue

CMS Releases Updated NGHP User Guide

CMS, Mandatory Insurer Reporting, Medicare Set-Aside Blog, MSP News on January 9, 2017 | Posted by Jean S. Goldstein, JD

CMS updated their Non-Group Health Plan (NGHP) User Guide, and released version 5.2.  The updated guide can be found here. The only update to the guide is the change in thresholds for reporting certain cases with total payment obligation to the claimant (TPOC), as indicated in CMS’ recently issued alerts and as previously discussed here […] Continue

CMS Special Open Door Forum to be Held

CMS, MSP News on January 4, 2017 | Posted by Jean S. Goldstein, JD

Yesterday, CMS announced that it will hold a conference call, a Special Open Door Forum, on Tuesday, January 17, 2017 at 3:00 pm EST.  The call will allow Medicare Secondary Payer stakeholders to learn and ask questions about changes involving the Social Security Number Removal Initiative, in general and in the context of MSP reporting. […] Continue