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nurse taking the blood pressure of an elderly woman

THE WHITTLING AWAY OF CMS OFF-LABEL USAGE ARGUMENTS IN THE WCMSA

With the transition to the new Workers’ Compensation Review Contractor (WCRC), the industry is seeing many changes in the Workers’ Compensation Medicare Set-Aside (WCMSA) review process. One of the biggest changes has been the shift from excluding Lyrica from the WCMSA when it is being prescribed for an off-label use to the inclusion of this […]

Failure to Properly Use the Conditional Payment Administrative Appeal Process

In Mouradian v. United States Government, the United States District Court for the District of Massachusetts found that a Medicare beneficiary did not exhaust the conditional payment administrative appeal process. Because the administrative appeal process was not exhausted, the District Court could not make a decision regarding whether the Medicare Secondary Payer Act (MSP Act) […]

CMS Data Entry Error Leads to Re-review

NuQuest staff works diligently to ensure that CMS approves proper MSA pricing. This was shown recently, when an initial CMS approval letter was higher than the MSA NuQuest submitted. “Upon review of the CMS allocation, we noted that CMS priced the venipuncture and comprehensive metabolic panel (CMP) higher than it should be per the workers’ […]

Medicare Secondary Payer Best Practices PRIMA Podcast with Patrick Czuprynski

Hear the Full PRIMA Podcast Here The Medicare Secondary Payer (MSP) Act has expanded the scope of workers’ compensation and liability claims beyond each individual state’s law concerning Medicare compliance. It also extends responsibility to plaintiffs’ attorneys, claimants of state, as well as self-insureds. As a result, it is vital to realize who is making […]

SUCCESS STORY REGARDING A CMS COUNTER HIGHER APPROVAL

At NuQuest, we strive to remain a strong leader in the MSA industry. One way we do so is to closely monitor the CMS approval process and to bring to their attention any improper judgments. The case study below is an example of how NuQuest takes the time to bring errors to light, not only […]

UPDATE ON NEW WCRC CONTRACTOR’S REVIEW OF DIAGNOSTICS AND PHYSICAL THERAPY

Since the new WCRC contractor took over, we have seen an increase in the amount of diagnostics and physical therapy allocated by CMS resulting in many counter higher determinations. These counter higher amounts seem to be an increase between 5 to 10% of the submitted MSA amount. Per the WCMSA Reference Guide, x-rays are allocated […]

Join Us on January 31st – NuShield Certified Compromise Webinar

Join Jennifer Shymanski, JD, CMSP, and Rasa Fumagalli JD, MSCC for a webinar on January 31st, 2018 from 1:00 to 1:30 pm CST to learn about the NuShield Certified Compromise MSA. Register here. The Certified Compromise MSA is an allocation that is apportioned from the net settlement. By comparing the various damage elements in a […]