The Official Medicare Set Aside Blog And Information Resource

THE UR/IMR PROCESS: STILL GOOD ON ITS FACE.

CMS, Independent Medical Review, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News, Work Comp on June 21, 2017 | Posted by Jean S. Goldstein, JD

The California Supreme Court has determined that it will not review a case involving an injured worker who asserted that the Independent Medical Review (IMR) process was unconstitutional.  This is good news for California payers, furthering the defensive position that payers can continue to rely on both the Utilization Review (UR) and Independent Medical Review […] Continue

Countdown to October – Are You Ready for LMSAs and NFMSAs?   

CMS, Liability, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News on June 5, 2017 | Posted by Jennifer Alvarez, JD, RN, MSCC, CMSP

We are currently four months away from CMS implementing their new workflows for Medicare Administrative Contractors (MACs), which outline how they will handle bills when there is a Liability Insurance Medicare Set-Aside Arrangement (LMSA) or No-Fault Insurance Medicare Set-Aside Arrangement (NFMSA) involved in the settlement.  You may be aware that, in February 2017, CMS took […] Continue

New Medicare Cards to Feature New Identifiers

CMS, Medicare Set-Aside Blog, MSP News, Social Security on May 31, 2017 | Posted by Jean S. Goldstein, JD

As reported several months ago, CMS has begun preparation of a new fraud prevention initiative that removes Social Security numbers (SSN) from all Medicare cards.  This initiative is the result of the passage of the Medicare Access and CHIP Reauthorization Act of 2015, which mandated the removal of the SSN-based HICN from Medicare cards.  Known […] Continue

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

How Will Mandatory Reporting Be Affected by CMS’ Announcements Regarding Thresholds?

CMS, Mandatory Insurer Reporting, Medicare Set-Aside Blog, MSP News on December 13, 2016 | Posted by Jean S. Goldstein, JD

CMS recently announced a change in the reporting thresholds to $750 for liability settlements, and advised that it would maintain the $750 threshold for no-fault and workers’ compensation settlements, where the insurer or entity does not otherwise have ongoing responsibility for medicals (ORM).  Just yesterday, CMS issued a technical alert regarding the change in reporting […] Continue

Is an MSA Technically a Trust?

Medicare Set-Aside Blog, Medicare Set-Asides, MSA Administration, MSP News on November 17, 2016 | Posted by Jennifer Jordan, JD, MSCC

In the early days of Medicare set-asides, we used to see the word “trust” thrown around quite freely. But from a legal perspective, the word trust carries very specific legal connotations that people didn’t want attached to MSAs, so little by little we saw the use of the word disappear. If professionally administered, you will […] Continue

Upcoming Enhancement to the Functionality of the Medicare Secondary Payer Recovery Portal

CMS, Conditional Payments, Mandatory Insurer Reporting, Medicare, Medicare Set-Aside Blog on November 13, 2015 | Posted by Erin O'Neill, PA-C, JD

The Centers for Medicare and Medicaid Services (CMS) has announced that the Medicare Secondary Payer Recovery Portal (MSPRP) will be updated to include functionality for obtaining a final conditional payment amount on those cases that are 120 days or less from an anticipated settlement. As part of the Strengthening Medicare and Repaying Taxpayers Act of […] 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

WC Opt Outs and MSAs

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, Work Comp on October 29, 2015 | Posted by Jennifer Jordan, JD, MSCC

In a recent blog post by Bob Wilson at WorkersCompensation.com [http://www.workerscompensation.com/compnewsnetwork/from-bobs-cluttered-desk/22602-federal-intervention-in-workers%E2%80%99-comp-will-opt-out-be-the-final-straw.html] about the opt out movement across the nation, he cautioned that federal intervention is probably not the solution to the workers’ compensation problem, citing the CMS oversight of MSAs as a prime example of why. But what I found interesting was that Bob likely […] Continue