The Official Medicare Set Aside Blog And Information Resource

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

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

Updated WCMSA Reference Guide Issued; Addresses Recent Alarming Trends

CMS, Medicare Set-Asides, MSP News on January 7, 2019
Posted by Jean S. Goldstein, JD

An updated Workers’ Compensation Medicare Set-Aside Reference guide was issued today.   The revised guide, version 2.9 can be found here. The updates in this guide are as follows: To eliminate issues around Development Letter and Alert templates auto populating with individual Regional Office (RO) reviewer names and direct phone numbers, these will now display the […] Continue

CMS to Begin Utilizing 2015 Life Table

CMS, Medicare Set-Asides, MSP News on December 11, 2018
Posted by Jean S. Goldstein, JD

Starting January 5, 2019, the Centers for Medicare and Medicaid Services (CMS) will begin using the CDC’s “Table 1: Life Table for the total population: United States, 2015” for Workers’ Compensation Medicare Set Aside (WCMSA) life expectancy calculations.  This means that for any WCMSA proposal received by CMS, or where any WCMSA case is reopened […] Continue

CMS Adds a Proposed Rule – Will it Affect Your Workers’ Compensation and Liability Claims?

CMS, Medicare Set-Asides, MSP News on December 10, 2018
Posted by Jean S. Goldstein, JD

The Centers for Medicare & Medicaid Services (CMS) recently added an item to the Unified Agenda, which may have an impact on your claims.  The Unified Agenda of Federal Regulatory and Deregulatory actions is a semiannual compilation of information about regulations under development by federal agencies published in the spring and fall.  The item added […] Continue

Structured Settlements in the Field

CMS, Medicare Set-Asides, Structured Settlements on October 24, 2018
Posted by Katharine Rupp, JD

In our last blog about structured settlements we reviewed the basics of what a structured settlement is and why you would want to structure a settlement. However, the benefits of structuring a settlement are best shown through real life examples. Below are three scenarios in which MEDVAL was able to provide creative settlement solutions utilizing […] Continue

Inclusion of Lyrica in Workers’ Compensation Medicare Set-Aside Arrangements

Medicare Set-Asides, Rx/Pharmacy, WCRC on October 11, 2018
Posted by Complex Claims Division

Lyrica (pregabalin) is an analog of the neurotransmitter gamma-aminobutryic acid, or GABA. Within the brain and nervous system, GABA plays an important role in behavior, cognition and the body’s response to stressful situations. A deficiency in naturally-occurring levels of GABA has been linked to conditions such as schizophrenia, depression, anxiety and various sleep disorders.  While […] Continue

Updated Guides Issued: WCMSA Reference Guide and Section 111 Reporting Guide

CMS, Medicare Set-Asides, MSP News on October 4, 2018
Posted by Jean S. Goldstein, JD

An updated Workers’ Compensation Medicare Set-Aside (WCMSA) reference guide has been issued.  The revised guide, version 2.8, can be found here. The revised WCMSA reference guide includes the following updates: Fields formerly labeled as “HICN” have been relabeled as “Medicare ID” and can accept either an Health Insurance Claim Number (HICN) or the new Medicare Beneficiary […] Continue