CMS Issues Financial Report for Fiscal Year 2010 Addressing WCMSAs

The below statement regarding WCMSAs was included in the financial report issued by Centers for Medicare and Medicaid Services’ (CMS) for fiscal year 2010 wherein they document an increase in the amount of approved WCMAs in the first 11 months of fiscal year 2010 due to CMS pricing of prescription drugs.  However, it is anticipated … Read moreCMS Issues Financial Report for Fiscal Year 2010 Addressing WCMSAs

SSA Implements SSN Randomization Project

Effective June 25, 2011, the Social Security Administration (SSA) will implement the SSN Randomization Project. The purpose of the SSA randomization initiative is to help protect the integrity of the SSN by establishing a new randomized assignment methodology. SSN randomization will also extend the longevity of the nine-digit SSN nationwide. SSN randomization will affect the … Read moreSSA Implements SSN Randomization Project

CMS Alert Regarding Upgrade of Query Files and HEW Software

On April 5, 2011, the Centers for Medicare & Medicaid Services (CMS) issued an alert providing information pertaining to the upgrade of Query Files and HIPPA Eligibility Wrapper (HEW) Software to ASC X12 270/271 Version 5010A1 under Section 111 of the Medicare, Medicaid and SCHIP Extension Act (MMSEA). The alert addressed the implementation and scheduled upgrade to the Eligibility Inquiry/Response set used for Section 111 Query Files and the HEW translation software.

This upgrade affects all Section 111 query files exchanged with the CMS Coordination of Benefits Contractor (COBC). Differences between Versions 4010A1 and 5010A1 are minor and adoption of Version 5010A1 should not be difficult. The upgrade to the new version of HEW software (Version 3.0.0) should be completed by January 1, 2012 by all Responsible Reporting Entities (RREs) using the current HEW software. Testing of the new version is recommended but not required.

Read moreCMS Alert Regarding Upgrade of Query Files and HEW Software

PMSI Meets with CMS Regarding Prescription Drug Allocation Issues

On September 20, 2010, PMSI Settlement Solutions met with CMS to continue our dialogue around the pharmacy portion of MSA allocations. Our main focus during this meeting was to address inconsistencies we are all experiencing in the interpretation of the May 14, 2010 Memorandum regarding Part D covered prescription drugs. PMSI addressed inconsistencies concerning off-label prescription drug usage, the appropriate treatment duration for acute drugs, and the re-review process. For example, we highlighted inconsistencies across reviewers at the Workers’ Compensation Review Center (WCRC) regarding the exclusion of drugs like Lyrica, Gabapentin and Lidoderm. PMSI also requested that CMS issue a formal directive in regards to which compendia will be utilized during the review process. We highlighted the need for policies and procedures that would support the various policy memos.

Read morePMSI Meets with CMS Regarding Prescription Drug Allocation Issues