Making Sense of the WCMSA Reference Guide 2.6

When the Centers for Medicare and Medicaid Services (CMS) released the latest Workers’ Compensation Medicare Set-Aside (WCMSA) Reference Guide on July 31, 2017, we anticipated more insights to new processes; but the new guide presents as many questions as it proposes to answer. Questions remain about how limits to WCMSA re-reviews will play out and […]

Amended Review and Other Takeaways from the Latest WCMSA Reference Guide

On July 31st 2017, the Centers for Medicare and Medicaid Services (CMS) released its most recent version of the Workers’ Compensation Medicare Set-Aside Reference Guide—and there’s a lot to digest. We received some clarification about how CMS will implement the new “Amended Review” option we wrote about previously. CMS also provided “clarifications” and changes for […]

Opana ER Will Be Removed from the Marketplace

Opana ER will be voluntarily removed from the marketplace, per the announcement last week of manufacturer Endo International plc. This follows the FDA’s suggestion that we blogged about last month—and it is an important next step in the fight against opioid abuse. No date has been set to remove the medication, but we’re closely monitoring […]

Shiny New Features for the WCMSA Portal

The Centers for Medicare and Medicaid Services (CMS) recently released an updated Workers’ Compensation Medicare Set-Aside Portal (WCMSAP) manual in conjunction with substantial changes to the portal. The most significant change is a new WCMSA re-review request option — please find a comprehensive analysis of this change here. Features Affecting Beneficiaries Two portal changes are […]

A Solid Second Bite: CMS Re-review Now Allows New Medical Documentation

Yesterday, the Centers for Medicare and Medicaid Services (CMS) released a new Workers’ Compensation Medicare Set-Aside Portal (WCMSAP) User Guide and updated its re-review process to include a third option: re-reviews of WCMSA decisions based on significant treatment changes. Prior Options Precluded CMS from Considering Current Changes in Treatment CMS’ informal process had limited re-review […]

Medicare Section 111 Process Change Eases One Compliance Burden

Medicare’s annual recertification process and update brings welcome news about Section 111 reporting and Responsible Reporting Entities (RREs). RREs will no longer automatically be moved into “discontinued” status if they fail to provide Medicare the requested annual recertification information. ISO Claims Partners became aware of some modifications in the recertification process and we asked Medicare […]