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 18.104.22.168 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 […]
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.
NuQuest/Bridge Pointe (NQBP) and myMatrixx have teamed up to maximize MSA savings potential and minimize the risk of prolonged settlement negotiations! This comprehensive solution identifies and optimizes opportunities to lower costs associated with both medical treatment and pharmacy utilization. The Pre-MSA with Drug Regimen Review (PMDR) combines a medical analysis and Drug Regimen Review to […]
On April 3, 2012, Government Accountability Office (GAO) released a report – “Medicare Secondary Payer – Additional Steps are Needed to Improve Program Effectiveness for Non-Group Health Plans” – reflecting challenges, workloads, average MSA amounts approved, and more. The full report is available here.
A reminder regarding the proper address for submitting annual accounting documentation to CMS’ Medicare Secondary Payer Recovery Contractor (MSPRC). Please send your completed annual Workers’ Compensation Medicare Set-aside Arrangement (WCMSA) Account Expenditure accounting documentation to the CMS lead Medicare Contractor at the address below: MSPRC – Non-Group Health Plan (NGHP) P.O. Box 138832 Oklahoma City, […]
The MSPRC has implemented a new fixed percentage recovery option that will be available to certain beneficiaries effective November 7, 2011. The “Fixed Percentage Option” gives beneficiaries who have physical trauma based Liability insurance (including self-insurance) settlements of $5,000 or less the ability to resolve Medicare’s recovery claim by paying Medicare 25% of the total […]
The Centers for Medicare and Medicaid Services (CMS) has announced a new fixed percentage option regarding Medicare’s recovery claims for certain liability (including self-insurance) settlements beginning November 7, 2011. To review CMS’ announcement, click here www.msprc.info This option will be available to beneficiaries who receive certain types of liability (including self-insurance) settlements of $5,000 or […]
The Centers for Medicare and Medicaid Services (CMS) has announced a $300 monetary threshold for certain liability cases. If the requisite threshold criterion is met, Medicare will not seek recovery against a beneficiary’s settlement, judgment, award or other payment. To learn more about CMS’ new $300 liability threshold, including the various criteria that must be […]
Smith v. Marine Terminals of Arkansas & American Home Insurance Company No. 3:09 CV 00027-JLH 2011 WL 3489806 (E.D.Ark.August 9, 2011) This case involved the settlement of an injury action arising under the Longshore Act. The parties reached a global settlement of the filed liability suit and workers’ compensation claim for $1M, with the workers’ […]