The Official Medicare Set Aside Blog And Information Resource

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

FINALLY—The Bid for the Workers’ Compensation Review Contractor (WCRC) Has Been Released.

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News on December 29, 2016 | Posted by Jean S. Goldstein, JD

CMS finally issued the solicitation for the Workers’ Compensation Review Contractor (WCRC) to review and evaluate workers’ compensation Medicare set-aside arrangements (WCMSA) submitted to CMS for review.  The WCRC’s role is to project future medical costs for those cases submitted as related to a workers’ compensation injury, illness, or disease that would otherwise be reimbursable […] Continue

2017: Shaping Up to Be the Year of CMS Changes

CMS, Medicare Set-Aside Blog, Medicare Set-Asides on December 22, 2016 | Posted by Jean S. Goldstein, JD

Just yesterday, CMS announced that in the coming year it will update its existing re-review process to specifically address cases where settlement has not occurred and a Claimant’s care has changed substantially since CMS issued an approval.  In the announcement, CMS also indicated that the re-review process will address situations for states that rely on […] Continue