The Official Medicare Set Aside Blog And Information Resource

Inclusion of Lyrica in Workers’ Compensation Medicare Set-Aside Arrangements

Medicare Set-Asides, Rx/Pharmacy, WCRC on October 11, 2018
Posted by Complex Claims Division

Lyrica (pregabalin) is an analog of the neurotransmitter gamma-aminobutryic acid, or GABA. Within the brain and nervous system, GABA plays an important role in behavior, cognition and the body’s response to stressful situations. A deficiency in naturally-occurring levels of GABA has been linked to conditions such as schizophrenia, depression, anxiety and various sleep disorders.  While […] Continue

Updated Guides Issued: WCMSA Reference Guide and Section 111 Reporting Guide

CMS, Medicare Set-Asides, MSP News on October 4, 2018
Posted by Jean S. Goldstein, JD

An updated Workers’ Compensation Medicare Set-Aside (WCMSA) reference guide has been issued.  The revised guide, version 2.8, can be found here. The revised WCMSA reference guide includes the following updates: Fields formerly labeled as “HICN” have been relabeled as “Medicare ID” and can accept either an Health Insurance Claim Number (HICN) or the new Medicare Beneficiary […] Continue

Conditional Payments: When Does the Time Clock Run Out?

Conditional Payments, Medicare Advantage, MSP Litigation on October 1, 2018
Posted by Jean S. Goldstein, JD

Last week, in MSPA Claims 1 v. Kingsway Amigo Ins. Co.,  the 11th Circuit addressed the appropriate application of the statute of limitations under the Medicare Secondary Payer Act (MSPA).  At issue in the matter, was whether the Plaintiff, an assignee of a Medicare Advantage Organization (MAO), timely pursued a claim against the Defendant, a primary […] Continue

The Opioid Crisis: What is the Government Doing About It? Part 2 – Improvements with Data Reporting, Collection and Analysis

Medicare Set-Aside Blog, MSP News on September 20, 2018
Posted by Complex Claims Division

This blog series is devoted to better understanding the efforts our Federal government is undertaking to combat the opioid epidemic in America. Earlier this year, the Department of Health and Human Services (HHS) announced a five-part strategy that will be utilized to combat the opioid epidemic. In part one of this series, we examined the […] Continue

FDA Approves Consensi™: A Novel Combination but a Conundrum for the Medicare Set-Aside

FDA, Medicare Set-Asides, Rx/Pharmacy on September 11, 2018
Posted by Complex Claims Division

On May 31st, the FDA approved Kitov Pharma’s application for Consensi™. Consensi is a unique combination product containing amlodipine, a calcium channel blocker used for the treatment of hypertension, and celecoxib, a non-steroidal anti-inflammatory used for the treatment of osteoarthritis. The product’s labeling will include a single indication for patients for whom treatment with amlodipine […] Continue

The Opioid Crisis: What is the Government Doing About It?

Opioids, Rx/Pharmacy on August 29, 2018
Posted by Complex Claims Division

There can be little doubt that the opioid crisis has reached staggering levels. The Centers for Disease Control and Prevention (CDC) statistics from 2016 reveal that on average, opioids killed about 115 Americans every day.[1] Drug overdoses have become the leading cause of death in Americans under the age of 50, with opioids accounting for […] Continue

Medicare Secondary Payer Recovery Portal (MSPRP) Overview Webinar Slides Now Available

CMS, Conditional Payments, MSP News on August 23, 2018
Posted by Jean S. Goldstein, JD

Last week, we posted about CMS’ overview webinar regarding the benefits of using the Medicare Secondary Payer Recovery Portal (MSPRP), a web-based application for managing Medicare recovery cases (or conditional payments).  The webinar slides from the webinar are now available for download here. If you have additional questions concerning the current functionality of the MSPRP, […] Continue

CMS Provides High Level Overview of MSPRP and Insight into Future Enhancements

CMS, Conditional Payments, MSP News on August 17, 2018
Posted by Jean S. Goldstein, JD

Yesterday, the Centers for Medicare & Medicaid Services (CMS), held an informative webinar to address the benefits of using the Medicare Secondary Payer Recovery Portal (MSPRP), a web-based application for managing Medicare recovery cases (or conditional payments).  The webinar was an overview explaining the various benefits of using the MSPRP, how to get started using […] Continue