The Official Medicare Set Aside Blog And Information Resource

California Proposition 64, and Other Marijuana Legislation: Are These Legislative Actions the Gateway to Marijuana Inclusion in Medicare-Set Asides?…Not Likely.

Medical Marijuana, Medicare Set-Aside Blog on February 6, 2017 | Posted by Jean S. Goldstein, JD

In 1996, California became the first state to allow for medical use of marijuana.  Marijuana is and remains classified as a Schedule I drug, which is defined by the United States Drug Enforcement Agency as, “substances with no currently accepted medical use and a high potential for abuse.”  Schedule I drugs also include drugs, such […] Continue

Is an MSA Technically a Trust?

Medicare Set-Aside Blog, Medicare Set-Asides, MSA Administration, MSP News on November 17, 2016 | Posted by Jennifer Jordan, JD, MSCC

In the early days of Medicare set-asides, we used to see the word “trust” thrown around quite freely. But from a legal perspective, the word trust carries very specific legal connotations that people didn’t want attached to MSAs, so little by little we saw the use of the word disappear. If professionally administered, you will […] Continue

Personal Injury Attorney Suspended for Poor Handling of Medicare Conditional Payment Reimbursement

Conditional Payments, Medicare, Medicare Set-Aside Blog, MSP Litigation on December 7, 2015 | Posted by Jennifer Jordan, JD, MSCC

Anyone can resolve a Medicare reimbursement. You don’t need to be a lawyer or MSP specialist. But the reason companies like ours exist is because CMS doesn’t make it easy. If you do not know how to navigate the process, it could take a long time. You may contact the wrong contractor and not receive […] Continue

Will the Supreme Court Help Us Figure Out What Will Happen When MSA Funds are Improperly Spent?

Commentary, Medicare Set-Asides, News and Events on November 9, 2015 | Posted by Jennifer Jordan, JD, MSCC

Theoretically CMS is supposed to deny related Medicare payments until such a time that it can be proven that an MSA was properly exhausted on related medical treatment. It is then that the question arises as to what will happen if the Claimant used the money and can’t pay for this own medical expenses. Our […] Continue

Management of Opioid Induced Hyperalgesia – The Impact on Workers’ Compensation Claims

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, Rx/Pharmacy, Work Comp on November 9, 2015 | Posted by Abidemi Oyebode, R.Ph., MBA - Clinical Pharmacist

The impact of opioid use in workers’ compensation claims has been widely researched and the shocking results continue to reveal that opioid use remains a very significant concern for workers’ compensation carriers. As evidenced by the NCCI Workers’ Compensation Prescription Drug Study: 2013 Update, the average narcotic cost per claim continued to increase as did […] Continue

CMS Will Not Finalize the Draft Lower Limb Prostheses Local Coverage Determination DL33787

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, Work Comp on November 4, 2015 | Posted by Erin O'Neill, PA-C, JD

On November 2, 2015, the Centers for Medicare and Medicaid Services (CMS) announced that the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) will not finalize the draft Lower Limb Prostheses Local Coverage Determination (LCD) DL 33787 at this time. This decision comes after a severe backlash from numerous stakeholder organizations regarding the proposed LCD. […] Continue

WC Opt Outs and MSAs

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, Work Comp on October 29, 2015 | Posted by Jennifer Jordan, JD, MSCC

In a recent blog post by Bob Wilson at WorkersCompensation.com [http://www.workerscompensation.com/compnewsnetwork/from-bobs-cluttered-desk/22602-federal-intervention-in-workers%E2%80%99-comp-will-opt-out-be-the-final-straw.html] about the opt out movement across the nation, he cautioned that federal intervention is probably not the solution to the workers’ compensation problem, citing the CMS oversight of MSAs as a prime example of why. But what I found interesting was that Bob likely […] Continue

CMS: Medicare Residual Payments for WCMSA Depletion & ORM Termination

CMS, Conditional Payments, Medicare Set-Aside Blog, Medicare Set-Asides on August 13, 2015 | Posted by Erin O'Neill, PA-C, JD

On August 6, 2015, the Centers for Medicare and Medicaid Services (CMS) issued instructions for the Shared Systems and Medicare Administrative Contractors (MACs) to follow when a Medicare Residual Payment must be paid on Workers’ Compensation Medicare Set-Aside Arrangements (WCMSA) or for Ongoing Responsibility of Medicals (ORM) Non-Group Health Plan (NGHP) Medicare Secondary Payer (MSP) […] Continue

Avinza Extended-Release Capsules No Longer Being Manufactured

Medicare, Medicare Set-Asides, Rx/Pharmacy on July 22, 2015 | Posted by Erin O'Neill, PA-C, JD

The Food and Drug Administration (FDA) has announced that all strengths of Avinza (morphine sulfate) extended release capsules have been discontinued. Avinza is a Schedule II long acting opioid medication indicated for the treatment of severe pain only. Avinza carried a black box warning indicating that misuse could lead to death due to the lack […] Continue