The Official Medicare Set Aside Blog And Information Resource

CMS Issues Updated Section 111 User Guide and Updated WCMSA Portal User Guide

CMS, Mandatory Insurer Reporting, Medicare Set-Asides on July 19, 2019
Posted by Jean S. Goldstein, JD

The Centers for Medicare and Medicaid Services (CMS) released two new updated guides earlier this month: an updated Section 111 Medicare Secondary Payer Reporting User Guide, and an updated Workers’ Compensation Medicare Set-Aside Portal User Guide.  Both of these guides contain very minor updates, which will not have a significant impact on the claims handling process.  […] Continue

CMS Issues Proposed Decision to Cover Acupuncture for Medicare Beneficiaries

CMS, Medicare Set-Asides, Opioids on July 16, 2019
Posted by Jean S. Goldstein, JD

Yesterday, the Centers for Medicare & Medicaid Services (CMS) issued a proposed decision to cover acupuncture for Medicare patients with chronic low back pain (cLBP) who are enrolled participants either in clinical trials sponsored by the National Institutes of Health (NIH) or in CMS-approved studies.  Currently, acupuncture is not covered by Medicare.  You may recall […] Continue

Appropriately Administratively Challenging Conditional Payments Saves Insurer from Double Damages

Conditional Payments, MSP Litigation, MSP News on June 26, 2019
Posted by Jean S. Goldstein, JD

Yesterday, an opinion on a familiar case came out of the Sixth Circuit [1].  The case is Duncan v. Liberty Mut. Ins. Co., Civil Action No. 16-CV-12570, 2019 U.S. Dist. LEXIS 106265 (E.D. Mich. June 25, 2019).  You may recall that we discussed this case previously here on our blog in August, 2018.   Last August, […] Continue

CMS Issues Final Rule for Medicare Advantage and Part D Pricing

CMS, Medicare Advantage, Rx/Pharmacy on May 22, 2019
Posted by Jean S. Goldstein, JD

Last week, the Centers for Medicare and Medicaid Services (CMS) issued a final rule, (CMS-4180-F) impacting Medicare Advantage Plans (MAP) and Part D programs.  The rule aims to ensure that patients have greater transparency into the cost of prescription drugs, so that beneficiaries can compare options and also enables MAPs to negotiate better prices for […] Continue

A Reversal of the Opioid Trend in California

Medicare Set-Asides, Opioids, Rx/Pharmacy on May 15, 2019
Posted by Leah King, PharmD, JD, Independent Pharmacy Consultant

In February, the California Workers’ Compensation Institute (CWCI) published a report that had some interesting findings regarding the use of prescription drugs. With respect to utilization, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen now rank above opioids as the most commonly prescribed medication class for workers’ compensation claimants. In terms of reimbursement, CWCI […] Continue