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
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.
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
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
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
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