On October 9, 2019 the Center for Medicare and Medicaid Services issued the Medicare Set-Aside Self Administration Toolkit. Although I feel like I'm condemning myself to an eternity in a very bad place for encouraging such a huge consumption of paper, EVERY injured worker who is going to self-administer a workers' compensation claim approved by … Continue reading Injured Workers Who Are Going to Self-Administer Their Medicare Set Aside Need This Guide
Category: Medicare Set Asides
Dust off That Medicare Set-Aside Evaluation-Oxycodone and Lyrica Prices Have Dropped
The Center for Medicare and Medicaid Services ("CMS) recently included generic versions of Oxycodone and Lyrica in its "Red Book". The "Red Book" is the pricing source for prescription medications utilized by CMS when evaluating whether an appropriate amount has been set aside to cover future medical expenses in a settlement of a workers' compensation … Continue reading Dust off That Medicare Set-Aside Evaluation-Oxycodone and Lyrica Prices Have Dropped
Why the Government Needs Medicare Set-Asides
Simply put, because Medicare is going broke. Fast. Based on the projections in the 2019 Medicare Trustee's report, the Medicare Hospital Insurance (Part A) trust fund will be depleted in 2026. No, that wasn't a typo: 2026 (that's 7 years from now). What is a Medicare Set-Aside? First things first. If you're new to this … Continue reading Why the Government Needs Medicare Set-Asides
New Guide Clarifies Employers’ Liability in Medicare Set-Aside Arrangements
On January 9, 2019 the Center for Medicare and Medicaid Services (“CMS”) issued its most recent Workers’ Compensation Medicare Set-Aside Reference Guide (“WCMSA”). A complete copy of the new WCMSA can be found here. Most notably, CMS added two examples of how settlements not meeting the CMS review thresholds still require a consideration of Medicare’s … Continue reading New Guide Clarifies Employers’ Liability in Medicare Set-Aside Arrangements
CMS Sues Yet Another Attorney for Failing to Reimburse Medicare
For many of you reading this the Center for Medicare/Medicaid Services (“CMS”) may sometimes feel like the bane of your existence. Gone are the good old days when you could settle the claim of an older worker secure in the knowledge that future medical payments for the injuries underlying the claim would be covered by … Continue reading CMS Sues Yet Another Attorney for Failing to Reimburse Medicare
Medicare Set-Aside Facts and Fiction-Part II
Here is the second part of my article for the Cleveland Metropolitan Bar Journal. There are some resources at the end of the article that might be helpful if you need to contact CMS regarding any MSA issues or, as discussed in this part of the article, if you are dealing with any Medicaid lien … Continue reading Medicare Set-Aside Facts and Fiction-Part II
Medicare Set-Aside Facts and Fiction
With speaking at SIGO's education day, writing an article for the Cleveland Metropolitan Bar Association and getting ready for another CLE, I've been a little delinquent with the blog, so my apologies. I've decided to use some of the material I put together for those events in the blog. This is Part One of an article I'm … Continue reading Medicare Set-Aside Facts and Fiction
CMS Announces Updated Life Tables
On December 11, 2017 the Center for Medicare and Medicaid Services (“CMS”) announced that it would begin referencing the CDC’s Table 1: Life Table for the total population: United States, 2014, for WCMSA life expectancy calculations. Any WCMSA proposals received on or after December 11, 2017, or reopened on or after that date, will be … Continue reading CMS Announces Updated Life Tables
Dealing With Medicare And Medicaid Liens When Settling A Workers’ Compensation Claim
Most people in the workers' compensation business are now well aware of the need to consider Medicare's interests when settling any workers' compensation claim. One thing that often goes unnoticed however, is the fact that Medicaid may also have an interest in a workers' compensation settlement. This is a brief overview of both programs, with … Continue reading Dealing With Medicare And Medicaid Liens When Settling A Workers’ Compensation Claim
CMS Allows Insurers A Second Chance With Their Medicare Set Aside Submissions
On July 10, 2017 The Centers for Medicare and Medicaid Services ("CMS") published a new Workers’ Compensation Medicare-Set Aside Portal ("WCMSAP") User Guide and updated its policy regarding reconsideration of unfavorable Medicare Set-Aside ("MSA") determinations. Previously CMS allowed for a very limited re-review process, reserved for situations where either: 1) CMS’ determination contained an obvious mistake, such … Continue reading CMS Allows Insurers A Second Chance With Their Medicare Set Aside Submissions
Employers Workers' Compensation Law Blog 