The Official Medicare Set Aside Blog And Information Resource

CMS Issues Updated Section 111 User Guide and Updated WCMSA Portal User Guide

CMS, Mandatory Insurer Reporting, Medicare Set-Asides on July 19, 2019
Posted by Jean S. Goldstein, JD

The Centers for Medicare and Medicaid Services (CMS) released two new updated guides earlier this month: an updated Section 111 Medicare Secondary Payer Reporting User Guide, and an updated Workers’ Compensation Medicare Set-Aside Portal User Guide.  Both of these guides contain very minor updates, which will not have a significant impact on the claims handling process.  […] Continue

CMS Issues Proposed Decision to Cover Acupuncture for Medicare Beneficiaries

CMS, Medicare Set-Asides, Opioids on July 16, 2019
Posted by Jean S. Goldstein, JD

Yesterday, the Centers for Medicare & Medicaid Services (CMS) issued a proposed decision to cover acupuncture for Medicare patients with chronic low back pain (cLBP) who are enrolled participants either in clinical trials sponsored by the National Institutes of Health (NIH) or in CMS-approved studies.  Currently, acupuncture is not covered by Medicare.  You may recall […] Continue

A Reversal of the Opioid Trend in California

Medicare Set-Asides, Opioids, Rx/Pharmacy on May 15, 2019
Posted by Leah King, PharmD, JD, Independent Pharmacy Consultant

In February, the California Workers’ Compensation Institute (CWCI) published a report that had some interesting findings regarding the use of prescription drugs. With respect to utilization, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen now rank above opioids as the most commonly prescribed medication class for workers’ compensation claimants. In terms of reimbursement, CWCI […] 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

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