The Official Medicare Set Aside Blog And Information Resource

FDA Greenlights Marketing of First Blood Test Designed to Aid in Diagnosis and Evaluation of Concussions

CMS, Medicare, Medicare Set-Aside Blog, MSP News on February 15, 2018 | Posted by Erin O'Neill, PA-C, JD

On February 14, 2018, the Food and Drug Administration (FDA) announced authorization of marketing of the Banyan Brain Trauma Indicator, which is the first blood test of its kind designed to aid in the evaluation of mild traumatic brain injuries (concussions) in adults. The blood test is designed to detect the presence of two protein […] Continue

Sublocade – A New Once-Monthly Injection for the Treatment of Opioid Use Disorder

CMS, FDA, Medicare, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News, Opioids on February 5, 2018 | Posted by Katherine Bales, RN, JD

The opioid crisis continues to be one of the most talked about issues facing the health care community, and the nation as a whole, having been declared a national public health emergency. In response, pharmaceutical companies have been actively working on ways to treat the crisis with the development of alternative treatment methods. The FDA […] Continue

CMS Releases Updated NGHP User Guide, Version 5.3

CMS, Medicare Set-Aside Blog on December 22, 2017 | Posted by Jean S. Goldstein, JD

CMS updated their Non-Group Health Plan (NGHP) User Guide, and released version 5.3.  The updated guide can be found here. The update to the guide essentially addresses CMS’ long planned transition, as previously reported, from use of Social Security Number (SSN) based Medicare identifiers to use of Medicare Beneficiary Identifiers (MBIs).  CMS provided an exemption […] Continue

WCRC Award Protests Denied

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News, WCRC on December 18, 2017 | Posted by Jean S. Goldstein, JD

As we previously reported, CMS awarded the Workers’ Compensation Review Contractor (WCRC) contract to Capitol Bridge, LLC, which was subsequently protested by two other companies who participated in the bidding process.  The protests were recently denied, but the decisions are covered by protective orders and must be redacted before being published.  Once available, the decisions […] Continue

CMS to Begin Utilizing 2014 Life Table

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News on December 13, 2017 | Posted by Jean S. Goldstein, JD

The CMS WCMSA web portal, where Workers’ Compensation Medicare Set Aside submissions are submitted to CMS for review, has alerted users that as of December 11, 2017, CMS will begin using the Table 1: Life Table for the total population: United States, 2014.  This means that for any WCMSA proposal received by CMS, or where […] Continue

Another Court Case, Perpetuating the Confusion Surrounding LMSAs

CMS, Liability, Medicare Set-Aside Blog, MSP Litigation on November 29, 2017 | Posted by Jean S. Goldstein, JD

Yesterday, a decision came out of the District Court for New Mexico, based upon an action to determine whether a Medicare Set-Aside was needed in a matter involving a personal injury suit.  (Silva v. Burwell, No. 16-cv-488 JCH/KK, 2017 U.S. Dist. LEXIS 195032, (D.N.M. Nov. 28, 2017).)  The applicability of the Medicare Secondary Payer act […] Continue

CMS Document SE17019 Reissued; The Effect This Document Has On Your MSA

CMS, Liability, Medicare Set-Aside Blog, MSP News on November 16, 2017 | Posted by Jennifer Alvarez, JD, RN, MSCC, CMSP

As we continue to monitor for guidance from the Centers for Medicare & Medicaid Services (CMS) regarding Medicare Secondary Payer (MSP) compliance and liability/no-fault insurance claims, we have noted a couple of recent changes.  First, on 10/27/17, the CMS Manual System was revised with transmittal 1954 [1], which addressed New Common Working File Medicare Secondary Payer […] Continue

Change is Needed: CWCI Study Provides Concrete Evidence of Over Inclusion of Opioids in WCMSAs

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, Opioids, Rx/Pharmacy on November 3, 2017 | Posted by Jean S. Goldstein, JD

This week, the California Workers’ Compensation Institute (CWCI) released a study documenting opioid use in Workers’ Compensation Medical Set-Asides (WCMSAs).  The study (for which MEDVAL contributed both data and advice concerning MSAs) focused on a specific dataset of CMS approved California WCMSAs from 2015 and 2016, against a control group of claims from 2006 through […] Continue

CMS Considering Voluntary Review of Liability MSAs, Again

CMS, Liability, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News on October 26, 2017 | Posted by Jean S. Goldstein, JD

On October 26, CMS once again issued an alert indicating it would be considering expanding the review of voluntary Medicare Set-Asides (MSAs) to include liability insurance and no-fault insurance (LMSAs and NFMSAs).  Just as with other alerts, today’s alert also states that CMS will work closely with the stakeholder community to identify how best to […] Continue

New Medicare Secondary Payer Recovery Contract Awarded

CMS, CRC, Medicare Set-Aside Blog, MSP News on October 9, 2017 | Posted by Jean S. Goldstein, JD

On October 5, the Centers for Medicare and Medicaid Services (CMS) awarded Performant Financial Corporation the Commercial Recovery Center (CRC) contract.  The contract was previously awarded to CGI Federal two years ago, when the CRC expanded and assumed responsibility for conditional payment recovery activities directly from Non-Group Health Plans (NGHPs). Performant is not a new […] Continue