The Official Medicare Set Aside Blog And Information Resource

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 Workers’ Compensation Review Contractor (WCRC) Contract Awarded

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News, WCRC on September 5, 2017 | Posted by Jean S. Goldstein, JD

Finally, a new Workers’ Compensation Review Contractor (WCRC) award has been issued.  This news comes after several months of work being completed by Provider Resources, the incumbent contractor, under an expired contract.  The new WCRC contract was awarded on September 1, 2017 to Capitol Bridge, LLC of Arlington, Virginia, a certified small business entity.  Capitol […] Continue

Settling a Case in Arizona?  What You Need to Know About Full & Final Settlements

Medicare Set-Asides, MSP News, State Regulations on August 3, 2017 | Posted by Jean S. Goldstein, JD

Historically, workers’ compensation claims in Arizona have been subject to a number of limitations.  If additional medical treatment was needed, a claimant could reopen a claim at any time, despite the finality and resolution of the claim.  As a result, settlement of workers’ compensation claims in Arizona have been far less common because these claims […] Continue

New WCMSA Reference Guide Issued

CMS, Medicare, Medicare Set-Asides, MSP News, Re-Review Process on August 1, 2017 | Posted by Jean S. Goldstein, JD

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

Eyes on the Prize: A New CMS Re-Review Option is Available.

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News, WCRC on July 10, 2017 | Posted by Jean S. Goldstein, JD

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

Will the WCRC Award Be Announced Tomorrow?

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, WCRC on June 29, 2017 | Posted by Jean S. Goldstein, JD

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 UR/IMR PROCESS: STILL GOOD ON ITS FACE.

CMS, Independent Medical Review, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News, Work Comp on June 21, 2017 | Posted by Jean S. Goldstein, JD

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

Countdown to October – Are You Ready for LMSAs and NFMSAs?   

CMS, Liability, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News on June 5, 2017 | Posted by Jennifer Alvarez, JD, RN, MSCC, CMSP

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

MAO Recovery & Courts: Aggressively Pursuing Liens

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, MSP Litigation, MSP News on March 17, 2017 | Posted by Jean S. Goldstein, JD

On Wednesday, in the second decision of its kind this month, the United States District Court, Southern District of Florida denied in part and granted in part a Motion to Dismiss in a Medicare Advantage Organization (MAO) Medicare Secondary Payer Act (MSPA) recovery claim. MSPA Claims 1, LLC, et al. v. Century Surety Company, No. […] Continue