The Official Medicare Set Aside Blog And Information Resource

A portent of things to come? CMS releases revised WCRC contract pre-solicitation

CMS, Liability, Medicare Set-Aside Blog, Medicare Set-Asides, News and Events on April 19, 2016 | Posted by Kimberly Wiswell, CMSP

CMS has revised their pre-solicitation for the WCRC contract with the following statement: ATTENTION: RFP-CMS-2016-8A-0008 PRE-SOLICITATION notice has been updated as follows. The Centers for Medicare and Medicaid Services (CMS) has adjusted the referenced solicitation for the Workers’ Compensation Review Contractor (WCRC) due to updates that are currently being made to the Statement of Work (SOW) […] Continue

FDA to Require Black Box Warning on All Immediate-Release Opioid Medications

Medicare Set-Aside Blog, MSP News, News and Events, Rx/Pharmacy on March 22, 2016 | Posted by Erin O'Neill, PA-C, JD

On Tuesday, March 22, 2016, the U.S. Food and Drug Administration (FDA) announced it will now require a black box warning on all immediate-release opioid medications. This warning will address issues regarding the risks of abuse, addiction, misuse, overdose and death. The FDA had indicated that immediate-release opioid medications should be reserved for individuals with […] Continue

CMS Admits to Backlog Due to Commercial Repayment Center Non-Group Health Plan Recovery Workload Transition

CMS, Medicare Set-Aside Blog, MSP News, News and Events on February 11, 2016 | Posted by Erin O'Neill, PA-C, JD

On February 11, 2016, the Centers for Medicare and Medicaid Services (CMS) released an Alert regarding the status of the transition of Non-Group Health Plan (NGHP) recovery activity from the Benefits Coordination & Recovery Center (BCRC) to the Commercial Repayment Center (CRC), which began on October 1, 2015. CMS identified that they are aware of […] Continue

Will the Supreme Court Help Us Figure Out What Will Happen When MSA Funds are Improperly Spent?

Commentary, Medicare Set-Asides, News and Events on November 9, 2015 | Posted by Jennifer Jordan, JD, MSCC

Theoretically CMS is supposed to deny related Medicare payments until such a time that it can be proven that an MSA was properly exhausted on related medical treatment. It is then that the question arises as to what will happen if the Claimant used the money and can’t pay for this own medical expenses. Our […] Continue

CMS Webinar Regarding Changes to the Non-Group Health Plan Recovery Workload

Medicare Set-Aside Blog, News and Events on August 25, 2015 | Posted by Erin O'Neill, PA-C, JD

On August 25, 2015, CMS held a webinar outlining the changes in workload processes and procedures in preparation for certain Non-Group Health Plan (NGHP) recovery activity to transition from the Benefits Coordination & Recovery Center (BCRC) to the Commercial Repayment Center (CRC). Effective October 5, 2015, the CRC will assume the responsibility for conditional payment […] Continue

Town Hall Teleconference for NGHP Section 111 Mandatory Insurer Reporting Scheduled for July 28, 2015

CMS, Mandatory Insurer Reporting, News and Events on July 15, 2015 | Posted by Jessica M. Wingenroth, JD

A Town Hall Conference call for policy and technical questions has been scheduled for Tuesday, 07/28/15, from 1:00 PM to 2:00 PM EST. Full details can be found here: http://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Mandatory-Insurer-Reporting-For-Non-Group-Health-Plans/Downloads/New-Downloads/NGHP-Town-Hall-Teleconference-Notice-July-28-2015.pdf Continue

Changes to the Non-Group Health Plan Recovery Workload

CMS, Conditional Payments, ICD-10, Mandatory Insurer Reporting, Medicare Set-Aside Blog, News and Events on July 1, 2015 | Posted by Erin O'Neill, PA-C, JD

Following the 2013 transition of most Group Health Plan (GHP) recovery activity to the Commercial Repayment Center (CRC), CMS has announced that certain Non-Group Health Plan (NGHP) recovery activity will also be transitioned to the CRC in the near future. Effective October 2015, the CRC will assume the responsibility for conditional payment recovery activities in […] Continue

CMS Quietly Proposing Adjustments to Future Medicaid Recovery Processes

CMS, Medicaid, Medicare Set-Aside Blog, News and Events, Work Comp on June 4, 2015 | Posted by Erin O'Neill, PA-C, JD

As noted in our previous post entitled “Medicaid Recoveries and Workers’ Compensation” it appears that Medicaid recovery efforts in workers’ compensation claims have begun in certain states. While it was uncommon in the past for worker’s compensation claimants to also be entitled to Medicaid, with the Medicaid expansion provided by the Affordable Care Act, greater […] Continue

Medicaid Recoveries and Workers’ Compensation

Medicaid, Medicare Set-Aside Blog, News and Events, Work Comp on June 3, 2015 | Posted by Jennifer Jordan, JD, MSCC

Let the games begin. It was recently reported to me that TPAs throughout the State of Kentucky were blanketed with “we understand that you may be responsible” letters for a number of state Medicaid recipients also on workers’ compensation. Don’t panic but we are about to embark on a whole new world of government bureaucracy […] Continue

Formal Appeal Rights for Conditional Payments for Applicable Plans

CMS, Medicare Set-Aside Blog, MSP News, News and Events on April 24, 2015 | Posted by Kimberly Wiswell, CMSP

For Medicare Secondary Payer (MSP) recovery demand letters issued on or after April 28, 2015 to liability insurance (including self-insurance), no-fault insurance, or a workers’ compensation entity as the debtor, these entities will now have formal appeal rights. On February 27, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a final rule implementing […] Continue