A Holiday Present from CMS

Foreshadowing a major change to Medicare Set-Asides (MSAs), the Centers for Medicare & Medicaid Services (CMS) announced on Wednesday, December 21, that it would unveil new policies in 2017 regarding re-review of MSAs and the use of utilization review in MSAs. The CMS announcement suggests that parties may soon be afforded a second bite of […]

Medication Trends to Watch

It’s no surprise that prescription medications are often the biggest cost driver in a Medicare Set-Aside (MSA). Physicians routinely prescribe costly medications to treat claimants’ injuries and manage their symptoms with the goal of returning them to normal activities as quickly as possible. Insurers can implement multiple strategies to reduce the overall cost of a […]

WCMSAP Rx Enhancement

The Centers for Medicare and Medicare Services (CMS) enhanced the Workers’ Compensation Medicare Set-Aside Arrangements portal (WCMSAP or portal) on October 6, 2014, by adding an additional step aimed at the collection of prescription information. This feature was established as part of the agency’s continuing efforts to automate and streamline the Medicare Set-Aside (MSA) review […]

Preparing for Mediation:
Medicare Checklist for WC Claims

It is no secret that Medicare Secondary Payer (MSP) compliance continues to complicate workers compensation (WC) claims practice. Unfortunately, far too often Medicare issues (especially the Medicare Set-Aside) end up sounding the death knell for settlement, thereby forcing WC claims payers to keep claims open and incur additional costs. The key to combating the MSP […]

CMS Releases Updated
WCMSA Reference Guide

The Centers for Medicare and Medicaid Services (CMS) has released an updated WCMSA Reference Guide (Version 2.3) dated January 5, 2015. A copy of WCMSA Reference Guide (Version 2.3) can be obtained here. This new release represents the agency’s eighth version of the guide to date since its initial release back in March 2013. Version […]

CMS Releases New Policy Regarding Hydrocodone & Other Controlled Substances

The Centers for Medicare and Medicaid Services (CMS) has announced a new policy starting January 1, 2015 regarding hydrocodone combination products and other controlled substances in relation to WCMSA proposals. As part of this new policy, CMS will require a minimum number of healthcare provider visits per year in situations where the claimant’s prescription regimen includes hydrocodone […]