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

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

Management of Opioid Induced Hyperalgesia – The Impact on Workers’ Compensation Claims

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, Rx/Pharmacy, Work Comp on November 9, 2015 | Posted by Abidemi Oyebode, R.Ph., MBA - Clinical Pharmacist

The impact of opioid use in workers’ compensation claims has been widely researched and the shocking results continue to reveal that opioid use remains a very significant concern for workers’ compensation carriers. As evidenced by the NCCI Workers’ Compensation Prescription Drug Study: 2013 Update, the average narcotic cost per claim continued to increase as did […] Continue

CMS Will Not Finalize the Draft Lower Limb Prostheses Local Coverage Determination DL33787

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, Work Comp on November 4, 2015 | Posted by Erin O'Neill, PA-C, JD

On November 2, 2015, the Centers for Medicare and Medicaid Services (CMS) announced that the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) will not finalize the draft Lower Limb Prostheses Local Coverage Determination (LCD) DL 33787 at this time. This decision comes after a severe backlash from numerous stakeholder organizations regarding the proposed LCD. […] Continue

MEDVAL to Attend the National Workers’ Compensation & Disability Conference & Expo

Medicare Set-Aside Blog, MEDVAL News, Work Comp on October 29, 2015 | Posted by Kimberly Wiswell, CMSP

An estimated 2,000 plus participants are expected to attend the National Workers’ Compensation and Disability Conference & Expo (NWCDC) in Las Vegas next month. In its 24th year, this is the leading event for workers’ compensation and disability management professionals. MEDVAL is pleased to be both an exhibitor and event sponsor. We invite you to […] Continue

Florida PIP Carriers Beware of a Potential Increase in MSP Reimbursement Demands

Liability, Medicare Advantage, Medicare Set-Aside Blog, MSP Litigation on September 11, 2015 | Posted by Jennifer Jordan, JD, MSCC

On August 28, 2015, the US District Court or the Southern District of Florida granted yet another motion to dismiss a MSP private cause of action for failing to demonstrate responsibility to make payment sufficient to trigger the Medicare Secondary Payer Act.  While at first I found the opinion rather insignificant given that this is […] Continue

Medicare Trust Fund Exhaustion Pushed Back Until 2030

Medicare on July 28, 2014 | Posted by Jennifer Jordan, JD, MSCC

In its Trustees Report released July 28, 2014, CMS announced that the Medicare trust fund will remain solvent until 2030, four more years than previously projected, due in part to cost controls implemented in the Affordable Care Act. Factors that contributed to the improved outlook included lower than expected spending in 2013 and decreased overall […] Continue