blackburn group inc.

April 2022





Our e-newsletter for Enterprise Risk Management, Claim Settlement and Healthcare Solutions.

During the past couple of months, we have seen Medicare take much more aggressive actions to enforce Medicare Secondary Payer (MSP) regulations.  Currently, we are analyzing and defending several beneficiaries who have been denied medical treatments due to MSP administration.  We anticipate there will be more cases of this type in the future.  As always, we thank you for trusting Blackburn Group with your business needs, and we will always strive for personalized care and excellence throughout this crisis and recovery process.


Robert J. Blackburn, Managing Principal

Medicare’s New Set Aside Guide Raises Administrative Concerns

On 3/15/22, Medicare amended the language from their January 2022 Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide saying they may deny payment for medical services that are not properly documented and managed.  Read more >>

More Risk, Claim and Healthcare News …

CMS Proposes New Rules for Settlement Reporting.  On March 1, 2022, the Office of Information and Regulatory Affairs received rules proposed by CMS that would establish civil monetary penalties of more than $1,000 per day against individuals or organizations that fail to report settlements as required by the Medicare Secondary Payer Act. The office’s approval is the final step before final adoption of the rules, which CMS first proposed more than two years ago.   View article...

Medicare Part B Drugs: Cost Implications for Beneficiaries in Traditional Medicare and Medicare Advantage.  Recently, Kaiser Family Foundation analyzed cost-sharing liability for these drugs in traditional Medicare and cost-sharing requirements in Medicare Advantage plans.  View article...

New Research Shows How Mindfulness-Oriented Recovery Enhancement Teaches Patients How to Manage Pain.  On February 28, 2022, a new study was published in the JAMA Network researching the question, “Does a mindfulness-based intervention reduce comorbid chronic pain and opioid misuse in the primary care setting more than supportive psychotherapy?”  View article…

California Independent Medical Review (IMR) Decisions Drop Significantly.  On 3/23/2022, a report from the California Workers’ Compensation Institute on the state’s independent medical review process used to resolve workers’ comp medical disputes shows the number of IMR decision letters continue to decline in 2021 to a new low. View article...

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