The Official Medicare Set Aside Blog And Information Resource

The Opioid Crisis: What is The Government Doing About It? Part 5 – Improving the Quality of Research on Pain and Addiction

CMS, Opioids, Rx/Pharmacy on February 15, 2019
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. Last year, the Department of Health and Human Services (HHS) announced a five-part strategy that will be utilized to combat the opioid epidemic. In previous posts, we have focused on the first four […] Continue

CMS Targets Medical Providers and “Other Interested Stakeholders” in Upcoming Part D Opioid Overutilization Policies Call

CMS, Medicare Set-Asides, Opioids on February 7, 2019
Posted by Jean S. Goldstein, JD

Next week, CMS will be holding a telephone call to discuss and answer questions regarding CMS’ new opioid policies for Medicare drug plans.  CMS finalized new policies for the Part D plans to follow starting January 1, 2019.  Through this initiative, CMS is seeking to strengthen and broaden its partnership with providers to address the […] Continue

CMS Releases Proposals that Will Likely Increase Medicare Advantage Plan Enrollment

CMS, Medicare Advantage, MSP News on January 31, 2019
Posted by Jean S. Goldstein, JD

Yesterday, CMS released Part II of a set of proposals that CMS indicates “will take significant steps in continuing the agency’s efforts to maximize competition among Medicare Advantage Plans (MAP) and Part D plans.”  Part I of CMS’ proposal was released on December 20, 2018 and included proposed updates to the Part C risk adjustment […] Continue

Acupuncture for Chronic Low Back Pain – Is Medicare Coverage Reasonable and Necessary?

CMS, Medicare Set-Asides, Opioids on January 24, 2019
Posted by Jennifer J. Mislanovich, JD

On 01/15/19, the Centers for Medicare & Medicaid Services (CMS) opened a National Coverage Analysis (NCA) to complete a thorough review of the evidence to determine if acupuncture for chronic low back pain is reasonable and necessary under the Medicare program. The public comment period is open until 02/14/19, a proposed decision memo due date […] Continue

CMS’ Updated WCMSA Reference Guide Emphasizes Importance of Satisfying MSP Obligations

CMS, Medicare Set-Asides, MSP News on January 9, 2019
Posted by Jean S. Goldstein, JD

Earlier this week, the Centers for Medicare & Medicaid Services (CMS) issued a revised Workers’ Compensation Medicare Set-Aside (WCMSA) reference guide, which we first alerted our readers to here on our blog.  Some of the changes found within the update guide addressed a few of the recent alarming CMS approval trends we have been tracking.  […] Continue

Updated MSPRP User Guide and MMSEA Section 111 NGHP User Guide Issued

CMS, Medicare Secondary Payer Recovery Portal, MSP News on January 8, 2019
Posted by Jean S. Goldstein, JD

It has certainly been a busy week for Medicare Secondary Payer news.  Aside from a updated Worker’s Compensation Medicare Set-Aside reference guide being issued, there has also been an updated Medicare Secondary Payer Recovery Portal (MSPRP) User Guide and an updated MMSEA Section 111 NGHP User Guide issued. We have addressed many of the revisions […] Continue

Updated WCMSA Reference Guide Issued; Addresses Recent Alarming Trends

CMS, Medicare Set-Asides, MSP News on January 7, 2019
Posted by Jean S. Goldstein, JD

An updated Workers’ Compensation Medicare Set-Aside Reference guide was issued today.   The revised guide, version 2.9 can be found here. The updates in this guide are as follows: To eliminate issues around Development Letter and Alert templates auto populating with individual Regional Office (RO) reviewer names and direct phone numbers, these will now display the […] Continue

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

CMS, Medicare Secondary Payer Recovery Portal, MSP News on January 2, 2019
Posted by Jean S. Goldstein, JD

We recently blogged about a webinar held by the Centers for Medicare & Medicaid Services regarding the additional enhancements coming to the Medicare Secondary Payer Recovery Portal (MSPRP) this week.  The webinar slides are now available for download here, and provide important information about the new self-reporting feature and the new multi-factor authentication process, as […] Continue

CMS Webinar Held Today: Changes to the Medicare Secondary Payer Recovery Portal Are Coming

CMS, Medicare Secondary Payer Recovery Portal, MSP News on December 18, 2018
Posted by Jean S. Goldstein, JD

Today, the Centers for Medicare & Medicaid Services held a high level overview webinar of the upcoming Medicare Secondary Payer Recovery Portal (MSPRP) enhancements, which as you may recall we addressed in our recent blog post:  Medicare Secondary Payment Recovery Portal (MSPRP) to Allow for Self-Reporting: Coming January, 2019. The purpose of the webinar was […] Continue