Today’s question implicates Medicare’s mandatory insurer reporting requirements. Identifying and understanding how to fulfill these obligations is an important element to claims handling, made critical by the proposed regulations outlining whether and how Medicare may penalize noncompliant entities.

Pregabalin has been in the top 10 prescribed drugs in the workers’ compensation realm and has recently seen a further decline in price.

As of April 1, 2020, Medicare Set-Aside (MSA) submissions must include an updated Consent to Release (CTR) form containing additional language indicating the claimant had the MSA process explained and the claimant approves of the contents of the MSA proposal.

Effective March 17, 2020, all local Social Security offices will be closed for in-person services in an effort to protect older Americans, and people with medical conditions that would be adversely affected by the virus and their employees.

The New York State Workers’ Compensation Board will no longer approve Section 32 Agreements that contain Medicare Indemnity and Hold Harmless language.

obic (meloxicam) is a nonsteroidal anti-inflammatory drug (NSAID) which is often part of the pain management treatment plan, and provides a non-opioid alternative. Per the Official Disability Guidelines, it is recommended at the lowest dose for the shortest duration.

Identifying and understanding how to fulfill Section 111 obligations is an important element to claims handling, made critical by the impending regulations outlining whether and how Medicare may penalize non-compliant entities.

CMS seeks to impose civil money penalties in a variety of situations, and affords a number of safe harbors and get out of jail free cards for responsible reporting entities. Interestingly, the proposal aims to use the conditional payment dispute and appeals process as a launching pad for possible civil money penalties.

A “counter-higher” refers to a specific type of determination issued by Medicare with respect to a submitted Workers’ Compensation Medicare Set-Aside Allocation (WCMSA). The question posed presumes the parties are settling for an amount that exceeds one of Medicare’s workload review thresholds: $25,000 for a case involving a Medicare beneficiary or $250,000 for a case involving a claimant with a “reasonable expectation of Medicare enrollment within 30 months of the date of settlement.”