The Official Medicare Set Aside Blog And Information Resource

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