VISUALIZE | INSIGHTS THAT POWER INNOVATION

Prescription Drugs

Bonneval Sebastien 1389597 Unsplash
July 8, 2020

Seven steps to closed: Maximizing claims settlement projects

There's a thin and potentially costly line between settling a claim and keeping it open. Using a claims settlement project can help close claims faster.

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October 31, 2019

CMS releases new WCMSA Reference Guide (Version 3.0)

CMS has released a revised Workers’ Compensation Medicare Set-Aside (WCMSA) Reference Guide (Version 3.0, October 10, 2019).

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October 29, 2019

As claim severity climbs, analytic insights hold key to containment

Insurers today are struggling with what seems like an intractable problem: the impact of rising claim severity on their bottom line. This upswing shows no sign of…

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August 1, 2019

WCMSA RX update – FDA approves first generics of Lyrica

On 7/22/19, the FDA announced it approved the first generics of Lyrica. This comes at a critical time as CMS has increasingly been including Lyrica in WCMSAs

Medical Treatment
May 28, 2019

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…

List
May 16, 2019

Reality check: Debunking the myths of Medicare Secondary Payer compliance

Medicare Secondary Payer is a challenging area of compliance for which federal law, regulations, and policy don’t always provide clear answers. It’s vital to understand…

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March 8, 2019

PAID Act Reintroduced in 116th Congress

On 2/26/19, Congressmen Ron Kind (D-WI) and Guy Bilirakis (R-FL) reintroduced the PAID Act as H.R. 1375 into the U.S. House of Representatives.

Wcmsaguide2
January 7, 2019

CMS releases new WCMSA Reference Guide (Version 2.9)

On 1/4/19, CMS released their latest version of the WCMSA reference guide Version 2.9.

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October 24, 2018

CMS updates its Medicare prescription drug benefit manual – New changes encourage Part D collection and recovery

The Centers for Medicare and Medicaid Services (CMS) has amended its Medicare Prescription Drug Benefit Manual (Part D Manual) to add, in part, stronger language…

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August 14, 2018

Drug formularies continue to expand in workers’ comp systems

Balancing rising medical and pharmaceutical costs with appropriate and timely treatment for injured workers has been an ongoing struggle for workers’ compensation…

Files
May 22, 2018

Arizona tweaks its "full & final" workers' comp settlement law - New law provides opportunities to settle workers' comp claims

Arizona Senate Bill 1100 provides unprecedented opportunities to settle workers' compensation claims in the state.

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May 9, 2018

Five steps to reduce your WCMSA costs

It is no secret that high Workers’ Compensation Medicare Set Aside (WCMSA) allocation amounts can complicate claim settlement.

Michael Longmire 1bbm4i6g2zm Unsplash
April 12, 2018

CMS issues new regulations aimed at identifying and limiting potential opioid abuse

On April 2, 2018, C,S issued a final rule which updated regulations for Medicare Advantage Plans (MAP) and Medicare Part D programs.

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December 19, 2017

CMS and opioid medications - Will CMS address opioids in 2018?

Currently, CMS takes a strict formulaic approach that will price all Medicare covered medication related to a claim at the present dosage and frequency for the “duration…

Adam Niescioruk Ty1li9vyjc8 Unsplash 1
November 27, 2017

Medicare Part D - The next recovery frontier?

Spurred by a number of favorable court decisions allowing MAPs to sue for “double damages” under the MSP statute, Medicare Part D plans are now beginning to step into the…