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 […]

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 […]

FDA request to remove Opana ER may be good news for WCMSAs

The FDA has recently intervened in the escalating fight against opioid abuse. The agency has requested that Opana ER, a long-acting opioid medication, be removed from the market due to the high risk of users crushing the pill to inject it. This manipulation of the medication has not only led to a higher risk of […]

CMS Will Use the New 2012 CDC Life Table for WCMSAs

On March 8, 2017, the Centers for Medicare and Medicaid Services (CMS) announced that beginning April 1, 2017, it will use the new 2012 CDC Life Table to calculate life expectancies in Workers’ Compensation Medicare Set-Asides (WCMSAs). The table correlates a person’s age with anticipated life expectancy, so CMS uses it to determine the appropriate […]

2017 Medicare Watch List

As the first quarter of 2017 comes to an end, it’s clear there will be no shortage of Medicare Secondary Payer (MSP) developments to keep an eye on this year. Here’s an outline of a few MSP events to watch in 2017: WCRC bid: Last year, the Centers for Medicare & Medicaid Services (CMS) opened […]