Workers’ Compensation Medicare Set-Aside (WCMSA)

CMS Releases WCMSA Self-Administration Toolkit 1.3

The Centers for Medicare and Medicaid Services (CMS) has released the latest edition of its Self-Administration Toolkit for Workers’ Compensation Medicare Set-Aside Arrangements (the Toolkit) (Version 1.3; October 10,...

Ninth Circuit: CIGA is not a “primary payer” under the MSP and does not have to reimburse Medicare

In a significant new case out of California, the United States Circuit Court of Appeals (Ninth Circuit) [1] in California Insurance Guarantee Association (CIGA) v. Azar , 2019 WL 5076945 (9 th Cir. Oct. 10, 2019)...

CMS Releases WCMSA Portal User Guide Version 5.9

The Centers for Medicare and Medicaid Services (CMS) has released the latest edition of its Workers’ Compensation Medicare Set-Aside Portal User Guide (WCMSAP) (Version 5.9; October 7, 2019). CMS outlines its full lis...

CMS Will Use the 2016 CDC Life Table for WCMSAs Starting 10/12/19

In an alert dated September 12, 2019, the Centers for Medicare and Medicaid Services (CMS) announced that beginning October 12, 2019, it will use the new 2016 CDC Life Table to calculate adjusted life expectancies in...

Proposed Workers’ Compensation Medicare Set Aside Reform Bill Filed in the U.S. House of Representatives

On August 2, 2019, Representatives Mike Thomson (D-CA) and George Holding (R-NC) introduced legislation aimed at reforming the Centers for Medicare and Medicaid Services’ (CMS) Workers’ Compensation Medicare Set-Aside...

WCMSA RX Update – FDA approves first generics of Lyrica

In a July 22, 2019 news release , the Food and Drug Administration (FDA) announced that it has approved the first generics of Lyrica. This announcement comes at a critical time as the Centers for Medicare and Medicaid...

Georgia Senate Bill 135 Adds Exceptions to the 400 Week Limit for Future Medicals – Overview and WCMSA Impact

Georgia Senate Bill 135 (SB 135) was signed into law on May 7, 2019 and makes notable changes to Chapter 9 of Title 34 of the Official Code of Georgia Annotated related to workers’ compensation. These new changes will...

Reality Check: Debunking the Myths of Medicare Secondary Payer Compliance

Medicare Secondary Payer (MSP) is a challenging area of compliance for which federal law, regulations, and policy don’t always provide clear answers. This often conflicts with the processes and procedures outlined by...

CMS to Mask Health Insurance Claim Number and Social Security Number on Contractor Correspondence Starting April 2019

The Centers for Medicare and Medicaid Services (CMS) has issued a reminder notice that starting April 1, 2019, its Coordination of Benefits and Recovery Program (COB&R) program will mask the social security number (SS...

Top 10 Medicare Secondary Payer Trends in 2019

Medicare Secondary Payer (MSP) compliance is a rapidly evolving area that has experienced significant changes in recent years, and 2019 looks to be no different. Policy changes, stricter regulations, new legislation,...