The Official Medicare Set Aside Blog And Information Resource

The Possibility of Settling Denied Arizona WC Claims is Off the Table; Senate Bill 1100 Transmitted to the House in Amended Form

Medicare Set-Asides, MSP News, State Regulations on February 22, 2018 | Posted by Jennifer J. Mislanovich, JD

As we noted last year, in our post “Settling a Case in Arizona? What You Need to Know About Full & Final Settlements,” Arizona enacted Senate Bill 1332 (SB 1332), allowing permanent closure of all medical benefits in accepted claim. Last month we thought it might be possible that denied claims would follow suit when […] Continue

FDA Greenlights Marketing of First Blood Test Designed to Aid in Diagnosis and Evaluation of Concussions

CMS, Medicare, Medicare Set-Aside Blog, MSP News on February 15, 2018 | Posted by Erin O'Neill, PA-C, JD

On February 14, 2018, the Food and Drug Administration (FDA) announced authorization of marketing of the Banyan Brain Trauma Indicator, which is the first blood test of its kind designed to aid in the evaluation of mild traumatic brain injuries (concussions) in adults. The blood test is designed to detect the presence of two protein […] Continue

Sublocade – A New Once-Monthly Injection for the Treatment of Opioid Use Disorder

CMS, FDA, Medicare, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News, Opioids on February 5, 2018 | Posted by Katherine Bales, RN, JD

The opioid crisis continues to be one of the most talked about issues facing the health care community, and the nation as a whole, having been declared a national public health emergency. In response, pharmaceutical companies have been actively working on ways to treat the crisis with the development of alternative treatment methods. The FDA […] Continue

CRC Contractor Transition Webinar Slides Available for Review

Conditional Payments, CRC, Medicare Set-Aside Blog, MSP News on January 26, 2018 | Posted by Jessica M. Wingenroth, JD

CRC Webinar Slides Available for Review If you missed the January 18th webinar introducing the incoming Commercial Repayment Center Contractor, Performant Recovery, Inc., those slides are now available for review. The presentation may be accessed via the Downloads section on the Coordination of Benefits & Recovery, What’s New page. You can also review our summary […] Continue

The CRC Dark Days are Coming, February 8 – 9, 2018

Conditional Payments, CRC, Medicare Set-Aside Blog, MSP News on January 18, 2018 | Posted by Jessica M. Wingenroth, JD

The highly anticipated Commercial Repayment Center (CRC) contractor transition from CGI Federal to Performant Recovery was discussed in a CMS Town Hall presentation this afternoon. The stated goal: seamless, painless and efficient transition with zero impact on Coordination of Benefits and Recovery activity. Ted Doyle, the project director of the incoming MSP CRC, assured the […] Continue

Meet the New CRC Contractor on 01/18/18

Conditional Payments, CRC, Medicare Set-Aside Blog, MSP News on January 15, 2018 | Posted by Jessica M. Wingenroth, JD

The industry has been invited to a CMS-sponsored webinar to introduce the new Commercial Repayment Center (CRC) contractor, Performant Financial Corporation, who will be taking up residence effective 02/08/18. As part of the transition, an informational webinar will be held for Non-Group Health Plan (NGHP) payers on 01/18/18 at 1:00 pm ET. A link to […] Continue

Take 2: MAO Class Action Fails on Second Amended Complaint

Medicare Advantage, Medicare Set-Aside Blog, MSP Litigation, MSP News on January 4, 2018 | Posted by Jean S. Goldstein, JD

As you may recall, several weeks ago we reported on a new spin in the Medicare Advantage Organizations (MAO) class action realm.  At the root of this latest private cause of action, is a multi-district ligation (MDL) suit involving a blood-thinning drug called Pradaxa.  The MDL settled in May, 2014, and by way of the […] Continue

WCRC Award Protests Denied

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News, WCRC on December 18, 2017 | Posted by Jean S. Goldstein, JD

As we previously reported, CMS awarded the Workers’ Compensation Review Contractor (WCRC) contract to Capitol Bridge, LLC, which was subsequently protested by two other companies who participated in the bidding process.  The protests were recently denied, but the decisions are covered by protective orders and must be redacted before being published.  Once available, the decisions […] Continue

CMS to Begin Utilizing 2014 Life Table

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, MSP News on December 13, 2017 | Posted by Jean S. Goldstein, JD

The CMS WCMSA web portal, where Workers’ Compensation Medicare Set Aside submissions are submitted to CMS for review, has alerted users that as of December 11, 2017, CMS will begin using the Table 1: Life Table for the total population: United States, 2014.  This means that for any WCMSA proposal received by CMS, or where […] Continue

More MSPA Claims 1 Cases Dismissed for Standing

Medicare Advantage, Medicare Set-Aside Blog, MSP Litigation, MSP News on November 27, 2017 | Posted by Jennifer Jordan, JD, MSCC

The U.S. District Court for the Central District of California dismissed the attempted class action against Mercury General on November 2, 2017. As with the other attempted national actions, standing was the fatal flaw in the pleadings as the plaintiffs fail to state who the alleged participating MAOs are. In order to demonstrate standing “[i]n […] Continue