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