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
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
CMS posted a notification on their website that they will begin to utilize the CDC’s Table 1: Life Table for the total population: United States, 2012 on April 1, 2017. This means that for any WCMSA proposal received by CMS, or where any WCMSA case is reopened on or after April 1, 2017 CMS will apply […] Continue
In September 2016, House Representative Bill 6120 known as the Secondary Payer Advancement, Reconciliation, and Clarification (SPARC) Act was first introduced to Congress. The bill did not pass at that time, but was just recently reintroduced into the House of Representatives as HR 1122. Text of the recent bill is not yet available. The bill […] Continue
CMS just issued an additional amendment to the RFP for the WCMSA review contractor. The amendment published additional responses to questions by offerors, and also a change in the due date for proposals to 10:00 am February 15, 2017. The amendment to the solicitation can be found here. Stay tuned for more details. Continue
Yesterday, CMS issued an amendment to the RFP for the WCMSA review contractor. The amendment published responses to questions by offerors, and informed offerors that additional answers to questions will be released on January 25, 2017. The amendment also reflects a change in the due date for proposals, to 10:00 am February 8, 2017. The […] Continue
It is commonplace for CT scans to be included in WCMSAs, in lieu of MRI scans, for Claimants with implanted intrathecal pumps; however, little thought is given to the reason for this substitution. Intrathecal pumps are small implanted programmable battery powered devices that dispense medication which is carried directly to the spinal cord by a […] Continue
CMS finally issued the solicitation for the Workers’ Compensation Review Contractor (WCRC) to review and evaluate workers’ compensation Medicare set-aside arrangements (WCMSA) submitted to CMS for review. The WCRC’s role is to project future medical costs for those cases submitted as related to a workers’ compensation injury, illness, or disease that would otherwise be reimbursable […] Continue
Just yesterday, CMS announced that in the coming year it will update its existing re-review process to specifically address cases where settlement has not occurred and a Claimant’s care has changed substantially since CMS issued an approval. In the announcement, CMS also indicated that the re-review process will address situations for states that rely on […] Continue