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CA Study Finds WCMSAs Include Significant Opioid Use

A recent California study of Workers’ Compensation (WC) Medicare Set Aside (MSA) cases shows almost 70% include future funding for opioid use, even as the nation faces an opioid epidemic.  The cases often exceed federal and state clinical guidelines which place claimants at a high level of risk for dependence and multi-drug interactions causing adverse effects.

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New WCRC Contract Negotiations Continue

Recently, the Centers for Medicare & Medicaid Services (CMS) awarded a new contract for Workers' Compensation Review Contractor (WCRC) administration to Capital Bridge, LLC, a small government contactor with 2 employees, for review of Medicare Set Asides (MSAs).  Two other companies submitting bids for the work have protested the award, and CMS has issued a stop work order.

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CIGA Win Assists Medicare Reimbursement Negotiations

In January of this year, the U.S. District Court for the Central District of California provided relief to the California Insurance Guarantee Association (CIGA) from Medicare demands that CIGA pay full invoices of provider charges, regardless of applicability to the referenced case.

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MSA RiskPro, a division of Blackburn Group, Inc., designs and creates Lien Verification and Negotiations, Medicare Set Asides (MSAs), Medicare Set Aside Trusts, Medicare Set Aside Accounts, Claim Management and Claim Settlement Solutions. We are recognized by A.M. Best Company as a Recommended Expert Service Provider in the Insurance, Claim Management and Financial industries.

MSA was founded as a specialized Medicare Set-Aside (MSA) insurance claim settlement solutions professional service and product company to address the needs of Workers Compensation and Liability claims under the Centers for Medicare and Medicaid Service (CMS) requirements according to MMSEA Section 111 (MMSEA 111).

What is a Medicare Set Aside? Under Section 1862 42 U.S.C. §1395y(b)(2) and § 1862(b)(2)(A)(ii) of the Social Security Act, Medicare is not responsible for paying a qualified injured person’s medical expenses when payment “has been made or can reasonably be expected to be made under a workers’ compensation plan, an automobile or liability insurance policy or plan (including a self-insured plan), or under no-fault insurance.” If the medical expenses are disputed in a personal injury situation, the provider, physician, or other supplier may bill Medicare as the primary payer. If the product or service is normally reimbursable under Medicare rules, Medicare may pay the expenses conditionally. Then if there is a subsequent settlement, judgment, award, or other payment, Medicare requires reimbursement of the expenses. For more information about your unique situation, ask our experts!

Blackburn Group, Inc.   RiskPro® is a registered trademark of Blackburn Group, Inc.