Feds pursuing Medicare conditional payment reimbursement from beneficiaries’ attorneys, as well as primary payers

Although we hear a great deal about Medicare becoming increasingly more aggressive with primary payers (responsible employers, corporations, insurers, self insured entities, and third party administrators), the federal government is also becoming just as unforgiving with beneficiaries’ attorneys. Pursuant to the Medicare Secondary Payer provisions of the Social Security Act, 42 U.S.C. § 1395y(b)(2), when Medicare … Read moreFeds pursuing Medicare conditional payment reimbursement from beneficiaries’ attorneys, as well as primary payers

FDA requires label changes for opioid analgesics to guide prescribers when gradual tapering is needed

This is a crosspost from the Optum Insights blog. The U.S. Food and Drug Administration (FDA) issued a safety communication in early April that requires changes to prescribing information for opioid analgesics used in outpatient settings. The goal is to expand the information available to health care providers and patients when opioid analgesics have been … Read moreFDA requires label changes for opioid analgesics to guide prescribers when gradual tapering is needed

Medicare Secondary Payer Recovery Portal enhancements ease payment process

Enhancements to the Medicare Secondary Payer Recovery Portal (MSPRP) have been announced by CMS that address electronic payment capabilities for identified Non-Group Health Plan (NGHP) conditional payment debt. CMS publicized the enhancements during a March 13, 2019, webinar.

This welcome enhancement, effective April 1, 2019, is more efficient and expedient, as opposed to the current process of sending reimbursement checks via the mail. Additionally, the payments have more visibility with tracking to ensure the payment is accurately applied. No additional user access or authorizations are required.

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Brand medication increases and generics for release in 2019

As an established Medicare Secondary Payer (MSP) compliance services provider, one of our goals is to keep clients, and the property and casualty insurance industry, informed of changes affecting MSP compliance and Workers’ Compensation Medicare Set Asides (WCMSAs).

As part of our best business practices, we continually monitor the RED BOOK® Average Wholesale Price (AWP) changes of the most common medications in WCMSAs as well as generic medications that come to market. This practice assists in identifying price changes that affect WCMSAs.

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