As you may be aware, on July 10th, here on our blog we announced the quiet release of a change to CMS’ re-review process. However, as we noted at that time, this process was not formalized by CMS, and had simply been released through CMS’ Workers’ Compensation Medicare Set-Aside Portal (WCMSAP). Specifically, through a revised WCMSAP User Guide, […] Continue
On July 6, 2017, Endo Pharmaceuticals issued a statement indicating it would voluntarily withdraw the opioid pain medication, Opana ER, from the market, in response to the Food and Drug Administration’s request one month earlier. As noted in our prior blog post, the FDA requested that Endo Pharmaceuticals withdraw Opana ER from the market, citing concerns of […] Continue
While all eyes (and ears) have been focused on the news, or the lack thereof of news regarding the Workers’ Compensation Review Contractor award, CMS quietly released a change to their re-review process today. The change was released through CMS’ Workers’ Compensation Medicare Set-Aside Portal (WCMSAP). Specifically, through a revised WCMSAP User Guide, which can […] Continue
With the 4th of July holiday, we allowed for some additional time for news of the Workers’ Compensation Review Contractor (WCRC) contract award to be announced. As you know, last week, we were anxiously awaiting the announcement. We were hopeful that this morning, we would wake up to the news that the award had been […] Continue
Tomorrow is June 30. Per the Centers for Medicare & Medicaid Services (CMS), we are expecting that the Workers’ Compensation Review Contractor (WCRC) award will be announced tomorrow. The WCRC is the entity responsible for projecting future medical costs that would otherwise be reimbursable by Medicare, for those cases submitted as related to a workers’ […] Continue
The California Supreme Court has determined that it will not review a case involving an injured worker who asserted that the Independent Medical Review (IMR) process was unconstitutional. This is good news for California payers, furthering the defensive position that payers can continue to rely on both the Utilization Review (UR) and Independent Medical Review […] Continue
We are currently four months away from CMS implementing their new workflows for Medicare Administrative Contractors (MACs), which outline how they will handle bills when there is a Liability Insurance Medicare Set-Aside Arrangement (LMSA) or No-Fault Insurance Medicare Set-Aside Arrangement (NFMSA) involved in the settlement. You may be aware that, in February 2017, CMS took […] Continue
As reported several months ago, CMS has begun preparation of a new fraud prevention initiative that removes Social Security numbers (SSN) from all Medicare cards. This initiative is the result of the passage of the Medicare Access and CHIP Reauthorization Act of 2015, which mandated the removal of the SSN-based HICN from Medicare cards. Known […] Continue
On May 3, 2017, the U.S. District Court for the Central District of California issued its order with regard to CIGA’s entitlement to relief following the court’s award of partial summary judgment in January. Based upon briefing submitted following that ruling, the Court concluded that CIGA is entitled to: an order vacating and setting aside […] Continue
Nationwide, states and workers’ compensation boards have been taking measures to curb the overprescribing and misuse of opioids and the crisis that has ensued as a result. Nonetheless, opioid addiction continues to be a growing concern. In an effort to help states combat the opioid epidemic, the U.S. Department of Health and Human Services (HHS) […] Continue