MSP Compliance Blog

Expert summary, analysis and recommendations on issues impacting Medicare Secondary Payer compliance.

PAID Act Becomes Law

Posted on December 16, 2020 by Daniel Anders

Insurance carriers to have access to Medicare Advantage plan enrollment information On December 11, 2020, President Trump signed into law HR 8900, Further Continuing Appropriations Act, 2021, which included the provisions of the Provide Accurate Information Directly Act or PAID Act…

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Celebrex and Abilify Price Drops Trigger MSA Reductions

Posted on December 14, 2020 by Daniel Anders

Recently, the lowest average wholesale price of Celebrex 200mg and the price of multiple strengths of Abilify dropped dramatically resulting in major cost savings to Medicare Set-Aside allocations.  A widely used, non-steroidal anti-inflammatory drug, Celebrex (Celecoxib), is FDA-approved for several conditions: Ankylosing spondylitis Juvenile rheumatoid…

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$750 Medicare Conditional Payment Recovery Threshold Remains for 2021

Posted on December 1, 2020 by Daniel Anders

In an 11/25/2020 Alert, the Centers for Medicare and Medicaid Services (CMS) announced that the 2021 recovery threshold for liability, no-fault and workers’ compensation settlements will remain at $750. Accordingly, Total Payment Obligations to the Claimant, TPOCs, in the amount of…

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November CMS Mandatory Reporting and Conditional Payment Updates

Posted on November 24, 2020 by artefact_admin

Please find below a summary of recent announcements from CMS. Medicare Conditional Payment Appeals Guide In follow-up to its September 2020 webinar on Medicare conditional payment appeals through the Commercial Repayment Center (CRC), CMS converted the slides into an appeals…

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New Ransomware Attack Threatens Healthcare Sector

Posted on October 30, 2020 by Jesse Shade

Tower’s cybersecurity partners, Avertium and Vigilant, have advised us of a major ransomware attack, primarily targeting the healthcare sector.  The threat actor, known as “Ryuk,” uses phishing e-mails to gain access and then control of the victim’s computer and ultimately…

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WEBINAR – Grasp Success in Settling WC Cases

Posted on October 28, 2020 by artefact_admin

A Chinese proverb says, “The temptation to quit will be greatest just before you are about to succeed.”  For workers’ compensation practitioners case closure represents success.  However, the impediments presented by the need for an MSA to close a case…

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Need a Second Opinion on an MSA?

Posted on October 27, 2020 by artefact_admin

Has a Medicare Set-Aside ever disrupted one of your settlements?  Any one of these things — unexpected medical, surgical or pharmacy costs, compliance issues, the way MSA administration will be handled, or the presence or absence of a structured settlement–can…

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CMS Rolls Out Updates to NGHP User Guide

Posted on October 22, 2020 by Daniel Anders

Earlier this month CMS released an updated MMSEA Section 111 Medicare Secondary Payer Mandatory Reporting User Guide (Version 6.0).  Here are the key updates with analysis and practical implications. Additional Definition of Total Payment Obligation to Claimant (TPOC) Section 6.4…

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CMS Adds New Pricing Resource to WCMSA Reference Guide

Posted on October 14, 2020 by Daniel Anders

In a recent update to its WCMSA Reference Guide, the Centers for Medicare and Medicaid Services released a state-by-state list of the major medical centers it uses for pricing future medical expenses in proposed MSAs.  This zip code-based list (See…

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What Gets Measured Gets Managed…. What’s Your Number?

Posted on October 12, 2020 by artefact_admin

In today’s digital environment, if you are an employer, carrier or TPA, you are likely inundated with data.  You get claims data, medical and pharmacy data, predictive analytics, benchmark performance data, claim reports, drug interaction, duplicate therapy and contraindication notices,…

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