Blog

blog image

Non-Submit MSAs: Buyer Beware!

On January 11, 2022, CMS released new guidelines regarding “Non-Submit” Medicare Set-Aside Allocations. Under §1.1, of Version 3.5 of its Workers’ Compensation Medicare Set-Aside Arrangement Reference Guide (Guide) “Clarification has been provided regarding the use of non-CMS-approved products to address future medical care (Section 4.3)” as follows: “A number of industry products exist with the […]

Read More
blog image

Can I borrow a couple of bucks? Medicare conditional payments

Medicare is a government program that provides health insurance benefits to those above 65 years of age, the disabled, and those with end-stage renal disease. Prior to 1980, Medicare generally paid for medical services whether or not the Medicare beneficiary was also covered by another health plan. Then the Medicare Secondary Payer law (MSP) was […]

Read More
blog image

What’s in a name? Medicare coverage of off-label prescriptions

When you get a prescription from your doctor for a medication, it is natural to assume that the medication is approved for treating the condition you are suffering from. However, very often this is not the case and your doctor has prescribed the drug for an off-label use. Off-label prescribing is when a doctor prescribes […]

Read More
blog image

Show Me The Money

You have settled your client’s workers’ compensation case and now its time for all the paperwork. In an effort to help the parties complete the settlement, the Centers for Medicare and Medicaid Services (CMS) has a reference guide setting forth the process it uses for approving proposed Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA). When a […]

Read More
blog image

The Gig Might Be Up: AB5 and Prop 22

California Assembly Bill 5 (AB5) was signed into law on September 18, 2019. AB5 limited the ability of business to classify workers as independent contractors rather than as employees. It gave workers more protections, including worker’s compensation benefits, minimum wage laws and sick leave. AB5 implemented a means for classification of employees known as the […]

Read More
blog image

Delay, Delay, Delay

California is ranked as one of the slowest states to start treating injured workers. The Workers’ Compensation Insurance Rating Bureau (WCIRB) wanted to conduct a survey to show the impact the Covid-19 pandemic was having on delaying care for injured workers. However, there was very little information available to them at the time so instead […]

Read More
blog image

Implications of CMS’s Revised Consent to Release Form

As of April 1, 2020, submissions of Workers’ Compensation Medicare Set-Asides (MSAs) must include CMS’s Revised Consent to Release form. The language indicates that the need and process for the MSA have been explained to the applicant and that the applicant has approved the contents of the MSA submission, including the amount of funds to […]

Read More
blog image

The Long Road Ahead

Long hauler, a term that we used to associate with truck drivers, has taken on a far more ominous meaning. In the age of Covid-19, a long hauler now refers to a Coronavirus Long Hauler. Covid-19 symptoms can last weeks or even months for some people. These patients are given the unenviable name “long haulers”. […]

Read More
blog image

Who Wants a Donut “Hole”?

It is very important when settling your client’s workers compensation claim that you take into consideration what will happen when your client’s Medicare Set-Aside funds are exhausted. Yes, Medicare will start paying for the costs for the work injury, but only if all the funds were spent according to Medicare’s strict guidelines. However, payment of […]

Read More