Conditional Payments Update: Thousands of letters and notices issued

In a brief alert issued on February 11, 2016, the Centers for Medicare and Medicaid Services (CMS) announced that since the October transition of conditional payment recovery from the Benefits Coordination and Recovery Center (BCRC) to the Commercial Repayment Center (CRC), the CRC has issued more than 33,000 conditional payment letters (CPLs) and new conditional […]

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 […]

CMS Releases Training Document Regarding RX Drugs and the WCMSA Portal

The Centers for Medicare and Medicaid Services (CMS) has released a training document regarding its upcoming plans to allow prescription drug information to be entered directly into the WCMSA Portal (WCMSAP). A copy of CMS’ new training document can be obtained here. This article outlines this new development as follows: Background                 By Alert dated August […]

Preparing for the ICD-10 Transition

The Centers for Medicare and Medicaid Services (CMS) released an alert in May 2014 announcing that the ICD-10 diagnosis codes reporting for Section 111 is postponed until October 1, 2015. A copy of the CMS alert can be obtained here. The delay in transitioning from ICD-9 to ICD-10 codes is a result of the Protecting […]

Is Cost-Shifting to P&C Payers on the Horizon?

There are numerous provisions of the Affordable Care Act (ACA), aimed at reducing the cost of America’s healthcare. According to Healthcare Finance News, the cost-saving strategies include specific reductions in reimbursements to providers of healthcare services for Medicare and Medicaid patients. For hospitals alone, these reductions will amount to some $150 billion over the next […]

Rhode Island Seeks Further Adoption of Medicaid Reporting

Since 2012, ISO ClaimSearch® has been working with its membership to increase reporting of qualified claims to the Rhode Island Executive Office of Health and Human Services (EOHHS), as required by Rhode Island law. The EOHHS has been disappointed with the overall adoption to date and believes only a minority of companies obligated under the […]