Category Archives: WCMSA

Blog, WCMSA

On October 2, 2012, the Centers for Medicare & Medicaid Services (CMS) issued a memorandum to Part D Sponsors concerning the transition to Part D Coverage of Benzodiazepines and Barbiturates beginning in 2013. Effective June 1, 2013, all  Workers’ Compensation Medicare Set-Aside (WCMSA) proposals submitted to CMS for a review of the adequacy of the proposal amount are to include …
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New WCMSA Reference Guide Posted

01 Apr 2013 Jesse Hamby No Comments

Blog, Medicare Set Aside, WCMSA

A new Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide has been posted and is available for download below. This reference guide was created to consolidate  information currently found within the Workers’ Compensation Agency Services webpages and CMS Regional Office Program Memorandums, while providing WCMSA information to attorneys, Medicare beneficiaries, claimants, insurance carriers, representative payees, and WCMSA vendors.   Please continue …
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WCMSA

The WCMSAP or Workers’ Compensation Medicare Set-Aside Portal has been improved to allow for two type of reconsiderations. These reconsiderations have been broken down by CMS into the follow two options: Option 1 If you believe CMS’s determination contains obvious mistakes (e.g., a mathematical error or failure to recognize Medical records already submitted showing a surgery, priced by CMS, that …
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Allocation, Medicare Conditional Payments, Uncategorized, WCMSA

On December 17, 2012 CMS announced they will be updating the life tables that allocators use when calculating life expectancy in WCMSAs. The impact will be an overall increase in life expectancy, although minimally, which will result in slightly higher costs in some situations. It is important to know that if a file has a pending WCMSA timely submission is …
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Blog, Medicare Set Aside, WCMSA

Katie A. Fox, MSCC – VP Medicare Compliance On August 1, 2012 CMS released yet another Memorandum providing guidance to MSA Allocators, as it pertains to pricing for Transcutaneous Electrical Nerve Stimulation (TENS) units included within submitted Workers’ Compensation Medicare Set-Aside (WCMSA) proposals.   CMS has defined Chronic Low Back Pain (CLBP) as the following: “an episode of low back …
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Lyrica: No Brand-Name Swansong

27 Jul 2012 Roy Franco No Comments

Medicare Conditional Payments, Pharma Part D, WCMSA

Lyrica is one of the most expensive chronically prescribed drugs used in workers compensation spine/back cases. Lyrica is a anticonvulsant drug used to treat chronic neuropathic back or spine pain, such as pain in a leg that persists after a lumbar spine injury. Prior to Lyrica, Gabapentin had been the primary anticonvulsant drug used for neuropathic pain, and its cost …
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New Jersey No Longer Mandates WCMSA in WC Settlements

27 Jul 2012 Roy Franco No Comments

Medicare Set Aside, WCMSA

Katie A. Fox, MSCC VP Medicare Compliance – WC Alvena Ferreira, Senior Nurse Allocator Medicare Compliance is at the forefront of all parties in the resolution of a workers’ compensation claim. In 2005, Peter J. Calderone, Director/Chief Judge of Workers’ Compensation, issued the first Memorandum on Medicare Compliance. Chief Calderone has recommended periodic judicial review of the status of the …
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Blog, Medicare Set Aside, WCMSA

We previously thought Workers’ Compensation Medicare Set-aside Arrangements (WCMSA) funds were sacrosanct and not available for any other purpose, except to pay for medical care related to the settled workers’ compensation injury.  This does not appear to be the case in Illinois.  A recent Appellate Court decision from the Third District of Illinois has muddied the waters for what was …
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Blog, Medicare Set Aside, WCMSA

The worker’s compensation system has been notorious for settlement of a “denied claim.” These are the claims where the cost to litigate the matter is greater than the settlement options. Thus, in exchange for a sum of money the Claimant agrees to discontinue their application for WC benefits. Over the years we have witnessed the Centers for Medicare and Medicaid …
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Medicare Reporting Section 111, ORM, WCMSA

Katie A. Fox, MSCC – October 21, 2011 The much awaited Version 3.2 of the User Guide was released on August, 17, 2011. The User Guide outlines several changes, but hidden in section 11.8 is a process to manually terminate the ORM status between Section 111 claim detail electronic submissions.  Throughout the industry the subsequent memorandums have gained much publicity, …
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