May 19, 2020 by Bridget Smith, JD CMS has released a new Workers’ Compensation Medicare Set-Aside Reference Guide, Version 3.1, May 11, 2020, COBR-Q2-2020-v3.1 a link to which can be found here: https://www.cms.gov/files/document/wcmsa-reference-guide-version-31.pdf This version of the Guide contained the new reference to the CDC life table 2017 that CMS has been utilizing for the […]
With the issuance of updated Workers’ Compensation Medicare Set-Aside Reference Guide version 2.9 (Guide), there has some speculation and even confusion as to what is really new and what is an elaboration of old policies and procedures. Examples listed for off-label drug usage to new bullets added regarding the submission process, all of which begs […]
Pursuant to Section 16.0 of the Workers’ Compensation Medicare Set Aside (WCMSA) Reference Guide, Version 2.8, October 1, 2018, COBR-Q4-2018-v2.8, CMS will conduct a Re-Review of a prior WCMSA determination in certain circumstances. Specifically, CMS will complete this process in cases involving a mistake in the allocation; mathematical error; or when there is missing documentation […]
Pursuant to Section 22.214.171.124 of the WCMSA Reference Guide, version 2.8, prescription medication pricing is based upon the Average Wholesale Price (AWP) of the drug with generic drugs being priced at the lowest non-repacked AWP rate. In accordance with WCMSA pricing guidelines, NuQuest submitted a WCMSA utilizing the lowest AWP price for a prescribed generic […]
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 […]
The Centers for Medicare & Medicaid Services (CMS) have implemented a new web-based tool designed to assist in the resolution of Liability, No-Fault, and Workers’ Comp Medicare recovery cases. The new tool is called The Medicare Secondary Payer Recovery Portal (MSPRP).
For CMS WCRC inquiries or help, call their new number—855.280.3550. Press 1: For English Press 2: For Spanish then Press 2: To enter the CMS Case Control Number (no letters) for customer service Press 3: To reach customer service directly
On June 8, 2012, CMS published its final decision regarding the use of TENS for CLBP. It has been decided that TENS is not reasonable and necessary treatment for CLBP and is no longer a Medicare-allowable expense. Click here for more information.
CMS seeks comment from industry professionals on options being considered for beneficiaries and their representatives to clarify how they can meet their obligations to protect Medicare’s interest in MSP Workers’ Comp or Liability claims. Comments must be submitted to CMS no later than 5 p.m. on August 14. Click here for more information.
CMS has provided a new phone number for the Workers’ Compensation Review Contractor effective as of July 2, 2012: The new phone number is 855-280-3550. CMS has not released any details regarding the new contractor as yet.