02.28.07
Posted in Uncategorized, Medicare Set-aside, Medical Case Management, Workers' Compensation at 8:08 pm by admin
The problem – Over the past several months the Medicare set-aside industry has experience a crisis of sorts. Medicare set-aside vendors are submitting a record number of claims for rated age quotes to as many as 10 different life insurance companies. We estimate that over 30,000 Medicare set-asides were done in 2006, each one generating on average five rated age submissions. As a result, the life insurance industry was hit with over 150,000 requests for rated age quotes.
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02.25.07
Posted in Uncategorized, Life Care Planning, Medicare Set-aside, Medical Case Management, Workers' Compensation at 2:38 pm by admin
The Doughnut Hole
Medicare Part D provides Medicare coverage of certain prescription drugs for participating Medicare beneficiaries – referred to as “enrollees.†Depending on which prescription plan an enrollee belongs to, they may face a coverage-gap known as the “doughnut hole.â€
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02.19.07
Posted in Uncategorized, Life Care Planning, Medicare Set-aside, Medical Case Management, Workers' Compensation at 9:44 am by admin
The ads read, “our pharmacist has generated X% savings on the total amount of prescriptions allocated.†The claim may be true, but is the amount allocated for prescriptions accepted by the Centers for Medicare and Medicaid Services, or more importantly, compliant with the Medicare Secondary Payer law?
At the end of 2005, CMS released the long-awaited “guidance†for inclusion of prescription medications in Medicare set-aside allocations. Since then, the workers’ compensation industry - and more so the Medicare set-aside vendor industry - has looked for ways to reduce the funding required to avoid a burden shift to Medicare for prescription drugs. Many believe they have found the answer in drug utilization reviews, or DURs.
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Posted in Uncategorized, Medicare Set-aside, Medical Case Management, Workers' Compensation at 9:39 am by admin
Recently, we have been asked why we are recommending Medicare set-aside allocations that include lifetime prescription drugs when other MSA vendors are only allocating three to five years worth. Aside from the common sense answer that a medically stable claimant who has a history utilizing prescription drugs is not likely to stop in any predicable time frame, much less within the next three to five years, the answer is simple – it’s the law.
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Posted in Uncategorized, Workers' Compensation at 9:32 am by admin
Recently there has been somewhat of a stir in the workers’ compensation and property & casualty insurance community about the import of Section 6035 of the Deficit Reduction Act of 2005 (“DRAâ€). The relevant aspects of the DRA are summarized below. Their effect on settling workers’ compensation and third-party liability claims is also addressed.
DRA
The DRA was signed into law on February 8, 2006. Among its purposes, the DRA was intended to reduce the cost of federal entitlement programs, including Medicaid. To this end, Section 6035 of the DRA, which had an effective date of January 1, 2006, clarifies the third-parties legally responsible for payment of claims for health care items or services.
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