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
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
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
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
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