Cases & Points Blog

Pregabalin (Lyrica) now available on the Red Book Database

CMS’ inclusion of Lyrica in certain Workers’ Compensation Medicare Set-Asides has caused allocations to increase significantly.  The Red Book, which is the pricing source for prescription medications utilized by CMS, has included brand name Lyrica at a cost of over $9.00 per pill.    As of July 1, 2019, Red Book now includes pricing for a […]

Senate Bill 135 Exceptions to Georgia 400 Week Limit and the Impact on WCMSAs

Pursuant to O.C.G.A Sec. 34-9-200, payment of medical expenses in workers’ compensation claims with dates of injury on or after July 1, 2013, were capped at 400 weeks for claims that were no-catastrophic in nature. Senate Bill 135, which will become effective on July 1, 2019, now eliminates the 400-week cap for certain medical items […]

CMS Issues Medicare Advantage and Part D Pricing Final Rule (CMS-4180-F)

On May 16, 2019, CMS issued the Medicare Advantage and Part D Pricing Final Rule (CMS-4180-F) which is aimed at providing greater transparency in prescription drug costs and enabling Medicare Advantage (MA) plans to negotiate better pricing for physician-administered medicines. The significant provisions of the final rule include the following: The final rule codifies existing […]

Commercial Repayment Center (CRC) Outreach Program: Getting to know your CRC Operator

Commercial Repayment Center (CRC) Outreach Program: Getting to know your CRC Operator NuQuest recently met with the operator of CRC, Performant Financial Corporation, as a part of their stakeholder outreach program.  Performant Financial Corporation began operating CRC in February of 2018. More about this can be found here. At the meeting, CRC provided a presentation […]

NuQuest Has A New Website!

Exciting news! We have launched the next generation of The website launch is part of an ongoing initiative to increase awareness of our large portfolio of service offerings. “As NuQuest offers much more than a traditional MSA product, we determined that it was time to better showcase our full portfolio,” said Tracey Lazzopina, CEO of NuQuest. […]

Now Available – CMS Electronic Payment Enhancement Overview

CMS has now posted the Electronic Payment Enhancement Overview Webinar presentations which were held on March 13, 2019, for NGHP and March 14, 2019, for GHP.  The presentations can be found in the Downloads section of the Coordination of Benefits & Recovery Overview What’s New page on

Join us on 4/4 – WCMSA Reference Guide Webinar

Join us on Thursday, April 4th at 2:00 PM (EST) with Bridget Smith and Jennifer Shymanski for a comprehensive analysis of the new WCMSA Reference Guide Version 2.9. We will review the various additions and changes to the new Guide and the potential impact these may have on WCMSAs.  Register here!

Picture of Lady of Justice Statute

Medicare Advantage Organization Recovery Rights

In published opinion filed on March 18, 2019, the United States Court of Appeals for the 11th Circuit affirmed the district court’s dismissal of MSPA Claims 1, LLC (MSPA) for failure  to sue a “primary plan” pursuant the private cause of action provisions in the Medicare Secondary Payer Act (MSP Act). In MSPA Claims1, LLC […]

CMS Hosts MSPRP Electronic Payment Enhancement Webinar

The March 13, 2019 webinar offered by CMS provided a description of the new direct payment features available through the Medicare Secondary Payer Recovery Portal (MSPRP) as of April 1, 2019.  CMS will be releasing presentation slides within five (5) to seven (7) days and will also be releasing the audio recording thereafter.  Some of […]