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Flector® (diclofenac epolamine) 1.3% topical patch is a nonsteroidal anti-inflammatory drug (NSAID) which is FDA indicated for acute pain due to minor strains, sprains and contusions. As with all NSAIDs, it is recommended to be used for the lowest effective dose for shortest duration possible. The Official Disability Guidelines do not recommend Flector patch as a first-line treatment. They further state there is no data to substantiate efficacy beyond two weeks.
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By Marty Cassavoy, VP MSP Compliance Standard operating procedure when settling a personal injury claim: parties should first determine if a plaintiff is a Medicare beneficiary, and once confirmed should comply with the Medicare Secondary Payer statute by ensuring that Medicare is repaid for any injury-related payments that it made. What happens when standard operating procedure breaks down? A recent $250,000 settlement in Maryland demonstrates that law firms can find themselves in the cross-hairs when these procedures are not followed.
By Patricia Strang, R.N., J.D., MSCC, CMSPMedicare Advantage plans have, in many areas, moved aggressively to wield the Medicare Secondary Payer "private cause of action" and obtain reimbursement for payments that they have made. Rarely have they run into a brick wall, but a recent case in the Eleventh Circuit Court of Appeals defies that trend.
By Lou Porrazzo Esq.The Centers for Medicare & Medicaid Services (CMS) hosted a webinar on March 13th for users regarding upcoming enhancements to the Medicare Secondary Payment Recovery Portal (MSPRP). As you are likely aware, the MSPRP focuses on personal injury recoveries only: workers' compensation, no-fault and liability insurance. The enhancements relate to electronic payment functionality available on April 1st 2019 and are as follows:
In 2015, the U.S. Bureau of Labor Statistics reported 2.9 million nonfatal workplace injuries occurred that year with 50 percent of the injured workers experiencing time lost from work.[1] The findings approximate that 75 percent of employees return to work after 12 weeks of lost work time, but only 20 percent return after a year. Simply stated, the longer injured workers are sidelined, the less likely it becomes that they will return to work at all. The failure to return to work is a poor outcome that affects an individual's physical and mental health as well as their personal, family, social, and economic well-being.
By Lou Porrazzo Esq. The Centers for Medicare & Medicaid Services (CMS) will host webinars on March 13 and March 14, 2019 for CRCP users regarding upcoming enhancements to the Medicare Secondary Payment Recovery Portal (MSPRP) and Commercial Repayment Center Portal (CRCP). Since the MSPRP focuses on personal injury recoveries only, workers' compensation, no-fault and liability insurance practitioners are advised to attend the March 13th webinar. The enhancements relate to electronic payment functionality available on April 1st. We applaud CMS for continuing to enhance and invest in self-service options that allow for swifter resolution of conditional payment claims and encourage CMS to allow for a robust question and answer period to address any ambiguities.
By Annie M. Davidson On Tuesday, February 26, 2019, the United States District Court for the Middle District of Pennsylvania held that the mere filing of a lawsuit by the Centers for Medicare and Medicaid Services ("CMS") is not enough to prove they were "forced to file" the subject lawsuit or not. The Court denied the government's motion for summary judgment where CMS sought to obtain full reimbursement of close to $84,000 in conditional payments. The Court found genuine issues of material fact exist around whether or not the government "had to pursue litigation" in this case.
There are multiple factors to consider when determining if a claim is reportable and when it should be reported to Medicare. In fact, CMS published nearly 4000 words on this topic in chapter 3, section 6.5.1 of the NGHP User Guide. In an attempt to provide you with the "basics" in a more palatable manner, we are publishing this article.
By Annie M. DavidsonWhat is supposed to happen and what actually happens for level three conditional payment appeals?
by Becky Bro, M.Ed, CRCDid you know that the average cost of a job accommodation is $500? In fact, according to a survey conducted by the Job Action Network (JAN), most employer/survey participants reported no cost, or low cost, for accommodating employees with disabilities. Of the employers who provided cost information related to the accommodations they had provided, 59% reported that the accommodations needed by their employees cost absolutely nothing, 36% reported they incurred a one-time cost, 3% reported having a reoccurring cost and only 1% of the employers surveyed reported their employee accommodations required a combination of a one-time and reoccurring cost to set up and maintain.
by Lori Dickson, MSN, RN, MSCC, CLCP, CNLCP
By Marty Cassavoy and Lori Dickson Earlier this week CMS released an updated version of its WCMSA Reference Guide. Version 2.9 provides no major substantive policy announcement but it does clarify some key issues that we have been closely following for a number of months. The updates concern two primary areas: policy and technical updates and injury and treatment-specific clarification.
ExamWorks Clinical Solutions remains committed to our local communities and charities. This year, during November and December, we are proud to launch our "Caring and Sharing" initiative. ExamWorks Clinical Solutions employees will be empowered to donate time to local charities which are personally meaningful to them within their local communities.
By Marty Cassavoy The holiday season is always a busy one for the Federal Medicare Secondary Earlier today Medicare hosted a brief webinar outlining two enhancements to the Medicare Secondary Payer Recovery Portal (MSPRP). If you blinked, you may have missed it, but the representative reading the presentation packed a ton of information into that 30 minute period. Here are the key items that you need to know:
By Marty CassavoyDecember is often quite a busy month in the Medicare Secondary Payer space, and this year is no different. On the heels of last week's announcement regarding possible regulations regarding the treatment of post-settlement medical, CMS unveiled its intention to file a notice of proposed rulemaking regarding civil money penalties in section 111 reporting, –albeit not until the third quarter of 2019. As with last week's announcement, the document is light on details. Here's the text of the announcement:
ExamWorks Clinical Solutions remains committed to our local communities and charities. This year, during November and December, we are proud to launch our "Caring and Sharing" initiative. ExamWorks Clinical Solutions employees will be empowered to donate time to local charities which are personally meaningful to them within their local communities.
By Marty CassavoyYesterday CMS announced a notice entitled "Miscellaneous Medicare Secondary Payer Clarifications and Updates," outlining an intention to release a new rule regarding Medicare Set Asides. The announcement is short on specifics, but explained that the potential rule would provide beneficiaries with "the opportunity to select an option for meeting future medical obligations that fits their individual circumstances." The full text of the notice, which can be found here, is as follows
By Nahla D. Rizkallah, PharmD, MSCC Lyrica has been a hot-button topic for claims involving Medicare Set Asides. Medicare's Workers' Compensation Review Contractor (WCRC) has been far more aggressive in incorporating Lyrica into Medicare Set Asides (MSAs) where submitters had been previously more successful in making "off-label" arguments to include MSAs. Underlying those changes has been the fact that Pfizer's patent on Lyrica was expected to expire on December 30, 2018.
By Marty CassavoyDuring this holiday week, it might be easy to miss a CMS update on portal enhancements and 2019 thresholds.
ExamWorks Clinical Solutions welcomes you to our LinkedIn Chronicle. In these brief articles, we will cover the ins and outs of all things related to Medicare Secondary Payer, MMSEA Section 111 Reporting, and Case Management. Our articles will uncover basic concepts and then move through the many nuances involved, helping you navigate the oftentimes complicated regulations and processes. In addition, our subject matter experts will be addressing and sharing FAQs and lessons learned.
Effective Stay At Work (SAW) and Transitional Return To Work (TRTW) programs are designed to add financial and intrinsic value by accomplishing three important business goals: 1) reduce disability leave costs, 2) maintain productivity of employees and work units, and 3) comply with disability-related legislation.
By Marty CassavoyA Federal Magistrate in a Massachusetts Federal Court dismissed a Navy veteran's attempt to have the reliance upon Treasury offsets to collect Medicare conditional payments declared unconstitutional. The decision to dismiss the case, predictably relies upon the exhaustion of administrative remedies. It is the unique facts of the case that highlight the pitfalls of dealing with an increasingly aggressive Treasury offset process. The case is cited as Mouradian v. United States Government, 2018 U.S. Dist. LEXIS 161863 (D. Mass.).
Allocation and pricing of medications within the Workers Compensation Medicare Set-Aside Arrangement (WCMSA) Part D is done so in accordance with the WCMSA Reference Guide as published by Center for Medicare and Medicaid Services (CMS). As a result, WCMSA medications are priced using the lowest average wholesale price (AWP) by the recognized proprietary source: Truven Health Analytics' Red Book database. Further, generic medications are priced at the lowest non-repackaged AWP.
By Marty CassavoyOctober 1st marks the start of a new quarter and the issuance of three updates covering all aspects of Medicare Secondary Payer compliance. Two updates involve minor changes to Medicare's User Guides, and the other incorporates additional functionality for the conditional payment portal. Here's a short summary of the updates, beginning with the most useful:
Did you know that millions of American workers who develop serious health problems or face work-place injuries every year are able to stay at work or return to work after a brief recovery period? However, approximately 1 in 10 of these sick and injured workers will experience a prolonged or permanent absence from the workforce due to their ailment. Although many of these prolonged absences begin as a very common health problem such as a musculoskeletal pain disability, they often end in unexpectedly poor outcomes, including job loss.
In the world of managing claim costs, prescription medication costs can be the most challenging to tackle. Often times, sights are set on that time when that one Brand-name medication will finally go generic in the hopes of lower cost equivalents available on the market. Sometimes it happens and sometimes it fails.
By Patricia Kent, Medicare Secondary Payer Compliance CounselCMS' new "Amended Review" process has been in place for a year. Amended Review allows parties to – in certain select circumstances – obtain a second shot at the Medicare Set-Aside approval. This new process is separate from the "standard" Medicare Set-Aside reconsideration process. Let's take a look.
By Marty CassavoyA new Medicare Set Aside bill was introduced in the House of Representatives on Thursday July 26th. The bill, which appears to be a companion to a bill previously introduced in the Senate on June 18th, is sponsored by Rep. Dave Reichert (R-WA) and co-sponsored by Rep. Mike Thompson (D-CA). The text on H.R. 6619 is not yet available however we would anticipate that it is more or less identical to S. 3079.
By Lou Porrazzo Earlier this month CMS introduced new elements to the Medicare Secondary Payer Recovery Portal. Last night CMS announced that it will hold a webinar on Thursday August 16th to walk through the new features. An overview of the webinar, including call-in instructions, can be found here.
The Industrial Commission of Arizona released updated advisory guidance for full and final settlements. The document provides a list of suggested Best Practices for Practitioners when resolving claims full and final in the State of Arizona.
With more than half of 2018 on the books, it's a good time to check in on Medicare's conditional payment process. There are a number of changes to Medicare's conditional payment program that had an impact on day-to-day claims handling – mostly for the better. Here's a recap of some of the key changes that we have seen this year.
Another average wholesale price (AWP) has changed! As part of best practices, ExamWorks Clinical Solutions continually monitors the Center for Medicare and Medicaid Services (CMS's) recognized proprietary source, Red Book, for real-time changes to AWP for medications used to treat the injured worker. It is noted that pricing of morphine sulfate products have been reduced considerably:
A new bill S. 3079 to revamp the Medicare Set Aside (MSA) process has been introduced in the U.S. Senate. The bill sponsored by Sen. RobPortman (R-OH) and co-sponsored by Sen. Bill Nelson (D-FL). Is known as the "Medicare Secondary Payer and Workers' Compensation Settlement Agreements Act of 2018," represents a stripped down version of previous Medicare Set Aside bills.
For many years we have all heard that Liability Medicare Set-asides are coming and are destined to either inflate settlements or elongate the process. Many in the industry like to use scare tactics to line their pockets with your allocated expense dollars. The truth is this…..
Allocation and pricing of medications within the Workers Compensation Medicare Set-Aside Arrangement (WCMSA) Part D is done so in accordance with the WCMSA Reference Guide as published by Center for Medicare and Medicaid Services (CMS). As a result, WCMSA medications are priced using the lowest average wholesale price (AWP) by the recognized proprietary source: Truven Health Analytics' Red Book database. Further, generic medications are priced at the lowest non-repackaged AWP.
A new decision from United States federal court in Connecticut opens the door for Medicare Advantage organizations (MAOs) to use the Medicare Secondary Payer statutes private cause of action provision to sue insurers in federal court. The case, Aetna v. Guerrera, involved a lawsuit under the private cause of action against all parties involved in a personal injury settlement – plaintiff, attorneys, and defendant. This case is a bit of a split decision for Aetna, but it does add Connecticut to the list of states where litigants must now be aware of Medicare Advantage prior to settlement.
On Wednesday March 7th the Centers for Medicare & Medicaid Services (CMS) introduced the new Workers' Compensation Review Contractor (WCRC). Effective Monday March 19th, Capitol Bridge, LLC will take over the WCRC responsibilities currently held by Provider Resources, Inc. The forty minute conference call provided an overview of Capitol Bridge's background and how the contractual transition will work. Here's a recap of the webinar:
In the ten years following the introduction of mandatory insurer reporting, we have yet to see any evidence of enforcement in the form of the imposition of dreaded civil money penalties. Could changes be on the horizon? Here's a primer on the civil money penalties provisions of mandatory insurer reporting.
Medicaid conditional payments appear to be dead. After five years of kicking the can down the road, Congress finally acted to resolve uncertainty surrounding when states will be able to expand their recovery rights. The recently signed Bipartisan Budget Act of 2018 permanently repeals a 2013 amendment to Federal law that allowed states to recover from non-medical portions of personal injury settlements. By including a permanent repeal of the provision, Congress breathes new life into two older Supreme Court cases whose holdings had been significantly curtailed by the 2013 amendment. State Medicaid programs will now be limited once again to proportional recovery from third-party settlements where a Medicaid program pays for medical treatment.
The Centers for Medicare & Medicaid Services (CMS) and Performant held a joint introductory webinar today, a little more than three months after Performant was announced as the "new" Commercial Repayment Center (CRC) Contractor. During the one-hour conference call, Performant representatives and CMS laid out the transition plan and fielded questions that they selected from an online queue. Here are key points all insurers, self-insureds and TPAs need to know:
ExamWorks Clinical Solutions (ExamWorks) announced today new Medicare Set Aside (MSA) post-settlement administration (PSA) features for professional administration and self-administration through its partnership with Ametros Financial. As a result of the alliance, Ametros' CareGuard™ and Amethyst™ healthcards will be available to ExamWorks Clinical Solutions clients who elect to use Ametros' post-settlement account services to simplify ongoing administration.
Earlier this year the Centers for Medicare and Medicaid Services (CMS) released a significant update to its Workers' Compensation Medicare Set-Aside (WCMSA) Reference Guide. As with any significant update, experience over time provides insight as to how the Workers' Compensation Review Contractor (WCRC) interprets the new guidance. Below is an update on what we see.
Like clockwork, count on the Centers for Medicare & Medicaid Services (CMS) to issue new guidance either around the Fourth of July or Christmas. This year is no different, as CMS released an updated NGHP Section 111 Reporting User Guide earlier this week. The changes are not earth-shattering, but are more substantive than the last several updates.
CMS responds with a short statement on opioids, but makes no commitment to review process or policy changes, leaving submissions to a trial and error process. Last month we reported on a study from the California Workers' Compensation Institute (CWCI) highlighting the link between the Centers' for Medicare & Medicaid Services (CMS) approval process and life-long opioids. The study, which followed approximately 8,000 CMS-approved Medicare Set Asides (MSAs) involving California workers' compensation claimants, made the case that CMS policy in this area was antiquated and in need of a re-boot.
In September of this year the Centers for Medicare & Medicaid Services (CMS) announced the award of a new Workers' Compensation Review Contractor (WCRC) contract to Capitol Bridge, LLC. That award was protested by two organizations – KEN Consulting and Arch Systems – the latter of which could have resulted in review by the existing contractor. The Government Accountability Office (GAO), which reviewed the protests, rejected the protests on Tuesday, December 12th. The protest decisions have not been published, but we anticipate they will be posted soon.
CMS announced it will maintain the existing $750 reporting and recovery thresholds for physical trauma-based liability settlements and for no-fault insurance and workers' compensation settlements, where the no-fault insurer or workers' compensation entity does not otherwise have ongoing responsibly for medicals. Settlements of $750 or less are exempt from conditional payment recovery as well as Section 111 reporting, notwithstanding ORM reporting obligations.
Last week the California Workers' Compensation Institute (CWCI) published a fascinating study on the intersection between the opioid crisis and Medicare Set Aside (MSA) review and approval. The CWCI data clarifies what many in the Medicare Secondary Payer compliance community have long known; the Medicare Set Aside review program inflates future medical care costs in a way that bears little relation to the actual needs of individual patients. Where opioids are concerned, the differences can be quite remarkable.
CMS awarded the next Commercial Repayment Center (CRC) contract to Performant Financial Corporation today. The news breaks on the two year anniversary of the launch of the CRC's ongoing responsibility for medicals (ORM) recovery program. Barring a bid protest the incumbent contractor, CGI Federal, will be phased out over the coming months.
ExamWorks Clinical Solutions, LLC, the industry leader in Medicare Secondary Payer compliance solutions and case management services, announced today that Jeffrey D. Gurtcheff has been appointed President and Chief Operating Officer. Mr. Gurtcheff, a 30 year industry visionary, has demonstrated exceptional leadership and innovation in the employ of industry leading third-party administrators, and insurers with a holistic understanding of workers' compensation, property and casualty, liability, and disability claim management.
On September 14th the Centers for Medicare & Medicaid Services (CMS) released the design of the new Medicare cards that it will begin sending to beneficiaries in April 2018. The new cards, which we have previously written about here, here, and here, are designed to substantially reduce the use of Medicare cards in fraud and identity theft.
ExamWorks Clinical Solutions ("ECS" or the "Company"), the industry leader in Medicare Secondary Payer (MSP) compliance and case management services and solutions, announced today that Martin R. Cassavoy joined the team as Vice President of Medicare Secondary Payer Compliance.
On September 1, 2017, the Centers for Medicare and Medicaid Services (CMS) announced the award of the WCRC contract to Capitol Bridge, LLC (Capitol Bridge). CMS began the contract renewal process back in December 2016 searching for an entity to "independently price the future Medicare-covered medical services costs related to WC injury, illness and disease, and to price the future Medicare covered prescription drug expenses." Capitol Bridge, designated as a minority owned business, was awarded the new $60.7 million contract until August 31, 2018. The award to Capitol Bridge replaces the current contractor Provider Resources, Inc. which has held the WCRC contract since 2012.
If you were unable to attend the "You Asked for WCMSA Re-Review & Medicare Answered: New Amended Review Process" webinar, you can watch it here now.
On July 27, 2017, the Centers for Medicare and Medicaid Services (CMS) released notification that they renamed the project aimed at removing Social Security numbers from Medicare cards. Up until now, CMS referred to the project as the "Social Security Number Removal Initiative" (SSNRI). The project is now titled the "New Medicare Card" project.
On July 10, 2017, the Centers for Medicare and Medicaid Services (CMS) released updates to its user guide for the Workers' Compensation Medicare Set-Aside Portal (WCMSAP). You may find a copy of the updated version (version 5.1) here. Below is a summary of the changes, and information on how these changes may impact your claims.
In a previous Industry News Bulletin, we noted that CMS seemed to be taking affirmative first steps on Liability Medicare Set-Aside Arrangements (LMSAs) and No-Fault Medicare Set-Aside Arrangements (NFMSAs). Since the time of that writing, we have seen a few revisions to the change request notice provided to Medicare Administrative Contractors (MACs). The most recent revision to the change notice was released on June 8, 2017. This change request issued by the Centers for Medicare and Medicaid Services (CMS) to its contractors continues to outline a timeline for back-end technical changes to modify Medicare's Common Working File (CWF) to address LMSAs and NFMSAs.
Recently you may have seen some back and forth about the plain language of the Medicare Secondary Payer (MSP) Statute found at 42 USC 1395y(b). The discussion focused on why the industry uses the phrase "consider or protect" when discussing Medicare compliance when those two words are found nowhere in the plain language of the statute and regulations (42 CFR 411 et seq.).
On May 8, 2017, Arizona Governor Doug Doucey signed an amendment impacting the workers' compensation law governing settlements that close out future medical treatment on admitted claims. The legislature voted to repeal Section 23-941.01[i] and replace it with an amended version[ii]. The old version allowed release of future supportive medical maintenance benefits, but disallowed closure of active treatment in admitted claims. The new amendment is effective as of October 31, 2017 and allows the closure of all future medical benefits by way of a settlement agreement if specific criteria are met.
In the midst of an "unprecedented opioid epidemic" (per the federal Department of Health and Human Services), the U.S. Food and Drug Administration (FDA) asked for withdrawal of Opana® ER from the market, a first ever! FDA Commissioner Scott Gottlieb states the opioid epidemic is a public health crisis and all necessary steps must be taken to reduce the scope of opioid misuse and abuse.
The Commercial Repayment Center (CRC) has been on the job for the last eighteen months. It's time for a progress report on this contractor, which has reset the timeline for conditional payment investigations.
At the most recent Department of Workers' Compensation (DWC) Educational Conference held on February 23rd, George Parisotto, Acting Administrative Director Division of Workers' Compensation, updated attendees on the status of the development of the California formulary. The formulary is set to go live on July 1st, 2017, and will be based on medical treatment standards set by the American College of Occupational and Environmental Medicine (ACOEM) in an effort to remain consistent with the Medical Treatment Utilization Schedule (MTUS) guidelines.
On February 17, 2017, Congressman Tim Murphy (R-PA) re-introduced the Secondary Payer Advancement, Rationalization, and Clarification Act, or SPARC Act. The bill is styled as HR 1122 and is co-sponsored by Rep. Ron Kind (D-WI). The aim of the SPARC Act is to clarify the Medicare Secondary Payer (MSP) program when Medicare Part D is involved.
Last week CMS released a change request to modify Medicare's Common Working File (CWF) to address a new Liability Medicare Set-Aside (LMSA) policy. The announcement establishes a timeline for back-end technical changes and provides clues to Medicare's new policy. A copy of the notice can be found here.
Summary of the SSN Removal Initiative Open Door Forum; One Key Field Name Change On January 17, 2017, the Centers for Medicare and Medicaid Services conducted a Special Open Door Forum to discuss the proposed changes in accordance with the Social Security Number Removal Initiative (SSNRI) of Section 501 of the Medicare Access and CHIP Reauthorization Act (MACRA).
On January 5, 2017 in the matter of California Insurance Guarantee Association (CIGA) v. Burwell(i), a Federal Court granted CIGA's Motion for Partial Summary Judgment and ruled that the Centers for Medicare and Medicaid Services (CMS) may not seek reimbursement for items or services unrelated to work injuries claimed by beneficiaries who were also covered by CIGA's policies. This case pronounces that CMS may only seek reimbursement for items and services related to the claim, which may be separate from other items and services billed by a provider under a date of service.
On Tuesday, January 3, 2017, the Centers for Medicare and Medicaid Services (CMS) scheduled a Special Open Door Forum to allow Medicare Secondary Payer (MSP) stakeholders the opportunity to learn and ask questions about upcoming changes to the Social Security Number-based Health Insurance Claim Numbers (HICNs). This conference call is a follow-up to the May 2016 informational bulletin regarding Section 501 of the Medicare Access and CHIP Reauthorization Act (MACRA), which requires CMS to remove SSNs from Medicare ID cards by April 16, 2019.
CMS announced yesterday that it expects to update its existing WCMSA re-review process. CMS indicated it plans to implement processes in calendar year 2017 to "address situations where CMS has provided an approved amount, but settlement has not occurred and the medical care that supported the approved amount has changed substantially." CMS also stated it expects the updated process to address situations where certain states rely on Utilization Review Processes to justify proposed WCMSA amounts.
After announcing last month that CMS was reducing the recovery threshold for physical trauma-based liability settlements from $1,000 to $750 for 2017, CMS has now issued an Alert that as of 1/1/2017 the mandatory reporting threshold for liability insurance Total Payment Obligation to the Claimant (TPOC) Amounts dated 1/1/2017 or after is changing from $1,000 to $750. CMS further announced that in 2017 it will maintain the $750 threshold for no-fault insurance and workers' compensation settlements, where the no-fault insurer or workers' compensation entity does not otherwise have ongoing responsibly for medicals (ORM).
Lawrenceville, GA., November 28, 2016 – ExamWorks Clinical Solutions (ECS) announced today an exclusive agreement with structured settlement broker, Chronovo, to deliver an innovative solution to the Medicare Set-Aside (MSA) space for workers' compensation and liability settlements, called the iMSA.
After announcing two months ago that CMS was maintaining the recovery threshold for physical trauma-based liability settlements at $1,000 for 2016, CMS has now issued an Alert that as of 1/1/2017 the liability recovery threshold will be reduced to $750. CMS further announced in this 11/15/2016 Alert that in 2017 it will maintain the $750 threshold for no-fault insurance and workers' compensation settlements, where the no-fault insurer or workers' compensation entity does not otherwise have ongoing responsibly for medicals.
The Centers for Medicare and Medicaid Services (CMS) released an updated version of the Medicare Secondary Payer Recovery Portal (MSPRP) User Guide (Version 3.5) which documents improved functionality and access on the MSPRP including portal use for matters pending with the Commercial Repayment Center (CRC). Given the delays in obtaining documentation from the CRC, the expansion of the portal to cover claims with the CRC is an improvement in CMS's Medicare conditional payment processes.
ExamWorks Clinical Solutions recently issued an Industry News Bulletin concerning an abrupt rule change to a long-standing CMS policy regarding approval of Legal Zero MSAs (see article here). CMS provided no notification of the rule change prior to the rule's implementation by the Workers' Compensation Review Contractor (WCRC). Accordingly, following our confirmation of the rule change with the WCRC, we immediately placed all Legal Zero MSA matters on hold and voiced ours concerns regarding this unannounced rule change to the CMS Central Office in Baltimore.
ExamWorks Clinical Solutions (ECS) was advised by the Centers for Medicare and Medicaid Services (CMS) that a Legal Zero MSA ("no liability" or "Zero allocation" MSA) based solely upon the employer or carrier's complete denial of the claim will not be approved. Such a denial is typically evidenced by a claim payment history documenting no payments for medical treatment and indemnity and a letter from the adjuster or defense attorney confirming such a denial.
A September 26, 2016 CMS Alert (Alert) announced the implementation of a $750 conditional payment recovery threshold for no-fault and workers' compensation settlements. CMS also announced it is maintaining the $1,000 conditional payment recovery threshold for liability settlements, a threshold which has been in place since January 1, 2014.
The 11th Circuit U.S. Court of Appeals, which includes Florida, Alabama and Georgia under its jurisdiction, has found that Medicare Advantage Plans (MAPs) may assign their rights of recovery under the MSP Act to another party. The consequence of the ruling is that MAPs or their assignees may assert a claim for reimbursement against no-fault and personal injury protection (PIP) plans for payments made by the MAPs deemed to be related to a claimed injury, including a claim for double damages.
Double Damages and MAPs – What You Need To Know: On August 8, 2016, the U.S. Eleventh Circuit Court of Appeals upheld an order from the lower federal district court granting summary judgment in favor of Humana[i] regarding Western Heritage Insurance Company's (Western's) obligation to reimburse Humana for Medicare benefits paid on behalf of its Medicare Advantage plan enrollee, Mary Reale, and its claim for double damages pursuant to the Medicare Secondary Payer Act (MSP). In affirming the district court's order, the Eleventh Circuit specifically agreed with and adopted the Third Circuit Court of Appeals' reasoning and holding in In re Avandia[ii] a prior successful decision for Medicare Advantage plans
A law passed in 2015 eliminated Social Security Numbers (SSNs) from Medicare ID cards, also known as Health Insurance Claim Numbers (HICNs). Congress and the President required use of a MBI to minimize the risk of identity theft for Medicare beneficiaries and to reduce opportunities for fraud within the program.
The Centers for Medicare and Medicare Services (CMS) is considering expanding the voluntary Workers' Compensation MSA review process to include review of liability and no-fault insurance MSA amounts. The June 9, 2016 notice states as follows:
On Monday, May 23, 2016, the Centers for Medicare & Medicaid Services (CMS) published a Technical Alert regarding new excluded diagnosis codes. The alert can be found here.
On May 17, 2016, the Centers for Medicare and Medicaid Services (CMS) published a final rule entitled "Medicare Program: Obtaining Final Medicare Secondary Payer Conditional Payment Amounts via Web Portal". While the rule will be effective June 16, the process defined by the rule was initiated by CMS in December 2015. See prior ECS article "CMS Initiates Process Allowing for Obtaining Final Conditional Payment Amount Pre-Settlement". The final rule provides the official guidance on the how and when this Pre-Settlement Final Conditional Payment process may be utilized by the settling parties.
CMS published a Bulletin on February 9, 2016 addressing issues encountered in implementation of Conditional Payment recovery actions against insurers. See bulletin here. According to CMS, the CRC has issued more than 33,000 Conditional Payment Letters (CPLs) and Conditional Payment Notices (CPNs) since the transition. CMS advised that it is aware that many insurers and WC entities are awaiting CPLs, CPNs, or demand letters. CMS has engaged with the CRC to improve responsiveness to requests for conditional payment information and the handling of correspondence.
One of the most significant recent developments in limiting unnecessary medical care costs in California workers' compensation came with the July 1, 2013, implementation of the Independent Medical Review (IMR) process. The IMR statute allows workers' compensation claimants to appeal Utilization Review (UR) denials of medical care with the resulting IMR determination binding upon the parties. Initially, the Centers for Medicare and Medicaid Services (CMS) refused to recognize IMR determinations as providing a basis for limiting medical care in a Medicare Set Aside (MSA), thus maintaining their normal practice of largely relying upon the opinions and recommendations of the treating physician to allocate future medical care. More recently, ExamWorks Clinical Solutions (ECS) has identified favorable trends in CMS recognition of IMRs in MSA submissions.
A suit under the Federal False Claims Act against more than 50 insurance stakeholders filed in the U.S. District Court for the Western District of New York has been dismissed. In 2011, Dr. Kent Takemoto filed this action to recover damages and civil penalties on behalf of the United States of America arising from insurers and self-insured companies for their alleged failure to repay known government obligations in violation of the Federal False Claims Act, 31 U.S.C. §§ 3729 et seq. Specifically, the suit requested damages for failure to comply with the obligations imposed by the Medicare Secondary Payer ("MSP") statute, 42 U.S.C. § 1395y(b)(2).
In late December CMS launched the long-awaited process for obtaining the final conditional payment amount prior to settlement. The process is very rigid in its requirements making very easy for one to run afoul of its strict timelines. ExamWorks Clinical Solutions is pleased then to offer this one-hour web presentation which will provide attendees a how to guide for utilizing this new process to obtain the final conditional payment amount pre-settlement. The presentation will also update attendees with the latest on actions by CMS's Commercial Repayment Center (CRC) to recover for conditional payments made during periods of ongoing responsibility for medical by the employer or insurer.
On Monday, December 21, 2015 the Centers for Medicare and Medicaid Services (CMS) published an Alert entitled: Modification of the Medicare Secondary Payer Recovery Portal (MSPRP) for Inclusion of Final Conditional Payment (CP) Process Functionality. CMS has completed the implementation of an electronic method that allows claimants or their authorized representatives to obtain the final conditional payment amount within three days of final settlement as opposed to initiating lien investigation and resolution in anticipation of settlement without a concrete time frame. The process through the MSPRP is very rigid in its requirements which may limit its usefulness to parties settling workers' compensation and liability cases.
On Tuesday, August 23rd, 2015 CMS held a webinar further explaining the new policies and procedures for conditional payment recovery through the Commercial Repayment Center (CRC) and the Benefits Coordination and Recovery Center (BCRC). On July 1, 2015, CMS first announced that it would be transitioning a portion of the NGHP recovery workload from the Benefits Coordination & Recovery Center (BCRC) to the CRC. CMS explained that the transition was part of a continuing effort to improve the conditional payment recovery and its accuracy in Medicare Secondary Payer (MSP) situations.
The latter half of 2014 and, thus far, 2015 have been busy times for Medicare Advantage Plans (MAPs) seeking clarification of their rights under the Medicare Secondary Payer (MSP) Act. MAPs, or "Part C providers" argue that the MSP Act and federal regulations outlining the right of Medicare Advantage Organizations are broad enough to allow providers of Medicare benefits to enjoy the same federal preemptive rights that Medicare Parts A and B routinely resort to when seeking recovery against settling parties. They argue that they are entitled to maintain a private cause of action against insurers who fail to reimburse them for care provided to a Medicare beneficiary and to recover double damages from those entities.
On Monday, July 13th, 2015 the Centers for Medicare and Medicaid Services (CMS) published version 4.7 of the MMSEA Section 111 Non-Group Health Program (NGHP) User Guide, found here.
On July 2, 2015, the Centers for Medicare and Medicaid Services published a bulletin outlining a change in procedure regarding Medicare Secondary Payer situations and limiting Medicare payments where Ongoing Responsibility for Medicals (ORM) exists.
The Centers for Medicare and Medicaid Services (CMS) has resolved the issue with the Section 111 mandatory reporting Medicare Eligibility Query matching process in which submission of a partial social security number (Last 5 digits) may result in claimants incorrectly being identified as Medicare beneficiaries. The prior announcement may be found here.
The Centers for Medicare and Medicaid Services (CMS) has discovered an issue with the Medicare Eligibility Query matching process when only a partial social security number (Last 5 digits) is provided. Partial social security number queries are a portion of the changes made to the Medicare reporting process with the enactment of the Strengthening Medicare and Repaying Taxpayers (SMART) Act of 2012.
On April 22, 2015, CMS published a downloadable document further explaining the recently available appellate rights granted to applicable plans/primary payers where Medicare seeks Medicare Secondary Payer (MSP) recovery directly from those applicable plans. The document can be found here. The CMS publication follows the final rule implementing certain portions of the Strengthening Medicare and Repaying Taxpayers (SMART) Act of 2012. Prior to passage of the Act, only Medicare beneficiaries were empowered to formally appeal the amounts to which Medicare claimed as reimbursable for treatment that is the responsibility of an applicable plan.
On Friday, February 27, the Centers for Medicare and Medicaid Services published its final rule implementing provisions of the Strengthening Medicare and Repaying Taxpayers (SMART) Act of 2012 regarding the appeals process for liability insurance (including self-insurance), no-fault insurance, and workers' compensation laws or plans when Medicare pursues a Medicare Secondary Payer (MSP) recovery claim directly from those entities (here).
Over the last year, the Centers for Medicare & Medicaid Services (CMS) has issued three key Alerts related to Mandatory Insurer Reporting.
On January 5, 2015, the Centers for Medicare and Medicaid Services (CMS) released an updated WCMSA Reference Guide, Version 2.3, which can be found here. The WCMSA Reference Guide provides the policies and procedures by which CMS and its contractor review Workers' Compensation MSAs submitted for approval. Since first being released in March 2013, CMS has made several updates to the guide.
On Tuesday, January 6, 2015 the Centers for Medicare and Medicaid Services (CMS) published version 4.4 of the MMSEA Section 111 Non-Group Health Program (NGHP) User Guide.
ExamWorks Group, Inc. announced that the Company completed the acquisition of Ability Services Network, Inc. ("ASN") and its subsidiary MedAllocators, Inc. ("MedAllocators"). The acquisitions of ASN and MedAllocators follows the Gould & Lamb acquisition completed in February 2014. ExamWorks also announced the creation of ExamWorks Clinical Solutions to manage its expanding Medicare compliance business.


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Upcoming Dates
San Marcos, TX 78666
512-353-3777 [map]
On Wednesday after work join Missoula for his long-running residency at Cheatham Street Warehouse. This early show features all-original songs, Special drink prices, friendly waitstaff and all-around happy campers! Come out to this historic music venue and relax to Missoula's sharp wit, cool songs and high-energy performances.
Austin, TX 78759
(512) 335-9504 [map]
The 4th Sunday of the Month, Missoula hosts Austin Songwriter's Group Open Mic from 7:30 to 10:30. ASG rocks! And, my friend, so do you!
Past Dates
Saturday, September 2nd, 2017
Lockhart, TX 78644
512-699-1901 [map]
Join Missoula at this new, way cool venue for an evening of original music, unique wines and craft beers!
Friday, September 1st, 2017
New Braunfels, TX 78130
830-629-3775 [map]
Awesome food, cold drinks and entertainment while you wait with original music from Missoula Slim! Come on out, ya'll!
Friday, July 28th, 2017
New Braunfels, TX 78130
830-629-3775 [map]
Come on out for some Cat Fish and bring the Kids! Great food, cold beverages and original music with Missoula Slim!
Saturday, July 1st, 2017
Lockhart, TX 78644
512-699-1901 [map]
Join Missoula for an evening of original music, tasty wines, craft beers and fun! This new Lockhart venue is fast becoming known for the high quality original music featured every weekend! See you there!
Friday, June 2nd, 2017
New Braunfels, TX 78130
830-629-3775 [map]
Come on out to this historic Cat Fish emporium and let Missoula entertain you while you wait for that giant plate of onion rings! Love it!
Sunday, May 7th, 2017
San Marcos, TX 78666 [map]
Join Missoula at this genuine Texas BBQ for great food, cold beer and original music!
Saturday, April 15th, 2017
Seguin, TX 78638
(830) 660-8124 [map]
Join Missoula and friends for a pot luck supper, ice cold craft beer brewed on premises and original music!
Saturday, January 14th, 2017
San Marcos, TX 78666
512-353-3777 [map]
Join Missoula for a full band performance of his new CD "9"!!! Missoula opens the show with an acoustic set, followed by performances from Aaron Allen, Dennis Jay, Robert Cannon and others. Band kicks out "9" later on. . . Please come out and have some fun!
Saturday, January 7th, 2017
Seguin, TX 78638
(830) 660-8124 [map]
Bring a dish and enjoy good people, fresh beer, food and music with Missoula Slim! Tremendous Fun!
Sunday, December 4th, 2016
San Marcos, TX 78666
512-353-3777 [map]
Missoula swaps songs with Big John Mills at this historic music hall. We go on at 4:15. Many songswaps, awesome songwriters, festive atmosphere! And all for a good cause. Come on out ya'll.
Saturday, December 3rd, 2016
Lockhart, TX 78644
512-699-1901 [map]
Tony and Bernadette Bowen are on the forefront of the emerging Lockhart Music Scene. Lover's of original songs of all varieties, Tony and Bernadette are devoted supporters of Texas music.
Join Missoula for a unique performance experience in this classy venue now emerging as one of Lockhart's premier listing rooms.
Fine wines, with a huge selection of craft beers and original chef creations coming soon. Desiderata Wine Estates is the place to be!

subset: commoncrawl


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Press Release
Columbia Sportswear Climbs to New Heights with EMC Symmetrix VMAX
EMC FAST VP and Flash Drives Help Innovative Outdoor Company Move to Over 95% Virtualized VMware Environment with Increased Performance and 25% Less Space
EMC Corporation (NYSE: EMC) today announced that Columbia Sportswear, a leading innovator in active outdoor apparel, footwear, accessories and equipment, is utilizing EMC® Symmetrix® VMAX™ storage systems with leading technologies including FAST VP (fully automated storage tiering for virtual pools) and flash drives (also known as SSDs) as the foundation of its rapidly expanding VMware environment and its journey to the cloud.
Customer Benefits:
- Reduced Footprint – Symmetrix VMAX enables 50% more VMware virtual machines to be supported in 25% less space; infrastructure is now more than 95% virtualized
- Greater Efficiency – Drive utilization to be increased by 40% using Symmetrix VMAX with EMC FAST VP
- Increased Savings – Automated tiering of FLASH, SATA and Fibre Channel Drives in Symmetrix VMAX reduced storage TCO by 40%
- Increased Performance – Symmetrix VMAX increased performance of VMware environment and enabled higher service levels and move toward cloud infrastructure
In 2009, Columbia set out to build a new, more efficient data center with enhanced disaster recovery and automation. After reviewing its requirements, Columbia decided that a move toward a cloud computing environment would be the best approach. In addition to EMC, Columbia considered storage systems, including; IBM, Hitachi, HP and others including 3Par, Dell, Lefthand and NetApp, ultimately selecting EMC.
"Our challenge was to build a data center with new levels of automation and the highest levels of protection," said Dan Hein Director of Global IS Shared Services. "We evaluated many vendors and ultimately selected EMC because of the features in Symmetrix VMAX, EMC's holistic view on storage with a variety of technologies and industry leading solutions that we knew we could count on."
Over the past 2 years, Columbia Sportswear's IT environment has evolved from 20%-30% virtualized to more than 95% virtualized. The four Symmetrix VMAX systems it deployed enabled more capacity to be stored in 25% less floor space and, more importantly, enabled a 50% increase in the number of virtual machines supported. The company is also implementing FAST VP and Flash drives as part of its automation strategy.
"The ability to tier our storage automatically using FAST VP will be a huge benefit to us," said Mike Leeper Senior Manager of IT Engineering. "We expect to increase our drive utilization by 40% while ensuring that the most frequently utilized data is automatically placed on the highest performing drives, to speed up application performance. And being able to take advantage of mixed drive configurations with Flash and SATA, managed by FAST VP, will also give us more flexible configurations with cost savings for our Tier 1 applications."
Columbia has virtualized nearly all of its critical applications including website transaction, supply chain, EP and SQL applications. In addition to Symmetrix VMAX, Columbia relies on a number of other leading EMC technologies in its infrastructure including: EMC RecoverPoint data protection technologies, EMC unified storage systems, EMC Data Domain deduplication technology and it also utilizes VCE Vblock Infrastructure Platforms.
About EMC
EMC Corporation is a global leader in enabling businesses and service providers to transform their operations and deliver IT as a service. Fundamental to this transformation is cloud computing. Through innovative products and services, EMC accelerates the journey to cloud computing, helping IT departments to store, manage, protect and analyze their most valuable asset — information — in a more agile, trusted and cost-efficient way. Additional information about EMC can be found at www.EMC.com.
Press Contacts
Jen Boucher
EMC, Symmetrix, VMAX, VNX, FAST VP, RecoverPoint and Data Domain are registered trademarks or trademarks of EMC Corporation in the United States and other countries. VMware is a registered trademark of VMware, Inc. in the United States and other countries. All other trademarks used herein are the property of their respective owners.


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Getting Started with Calling
Now that you have set up your Ooma Office Base Station, you are ready to get started with basic calling and further customizing your system! If you don't see what you're looking for, you can try searching our Knowledge Base and our helpful User Forums. If all else fails, you can contact our friendly Customer Care team, who are always happy to answer your questions!
The first thing that you will want to do when your Ooma Office Base Station is set up and running is to verify that you can make and receive phone calls. To get started, follow the instructions below:
Dialing out
You can make an external call by picking up your phone and dialing the outbound number as you normally would. You do not need to dial "9" or any other special code to make an external phone call.
Receiving incoming calls
You can answer a call by picking up the phone when it rings. To verify this, use your cell phone or ask a friend or colleague to dial the number that you selected when you activated your device.
If the Virtual Receptionist answers the call, dial your phone's extension number when you start to hear the welcome greeting.


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I was nominated for a Liebster Award from Muffin Nails. Thanks, Muffin!!
Since more than one person nominated me, I just chose my favorite questions from each one.
These are the rules:
1. Each person tagged must post 11 things about themselves.
2. They must also answer the 11 questions the 'tagger' has set for them.
3. They must create 11 more questions to ask bloggers they have decided to tag.
4. They must then choose 11 bloggers with less than 200 followers and tag them in their post.
5. These lucky bloggers must then be told.
6. There's no tag backs.
2. They must also answer the 11 questions the 'tagger' has set for them.
3. They must create 11 more questions to ask bloggers they have decided to tag.
4. They must then choose 11 bloggers with less than 200 followers and tag them in their post.
5. These lucky bloggers must then be told.
6. There's no tag backs.
11 fun facts about Lacey - My Boyfriend Hates Makeup:
1. My favorite nail colors are pinks, lilacs, pastels.
2. I cannot stamp for the life of me. You'll prob never see that here. Instead, you'll be subjected to my 3rd grade line drawing skills.
3. My children are my pets! I have two Shiba Inus and one Siamese. All are rescued!!!! I firmly believe in rescue. Shelby has a FB page if you want to see picks of my babies: Shelby Roberson!!
4. My real life occupations are history Professor at a community college and online marketing for a CD company.
5. I only stopped biting my nails in 2010, this is a new hobby!!
6. I wish I was better at consistency - blogging more, exercising more, doing anything longer than a week!
7. One day I will visit Fiji!!
8. I wish I was a professional singer. I sing constantly in my car. But never in front of others and I'd never ever do karaoke!
9. I have three tattoos, 2 hidden on my back and one on my wrist. My next one will be a world map.
10. I went skydiving for my 18th birthday and it was still one of the coolest things I've ever done!
11. My boyfriend really does hate makeup. There's never a moment where I dont hear "why are your hands slimy?" "do you have to put that on your face?" "you bought another polish?" "i'm pretty sure you have that color" UGH!!!
My answers:
1. If you could only buy three more polishes for the rest of your life, what would they be?
The first would have to be Connect The Dots by Lynnderella! It is such an awesome black/white topcoat with a fine silver shimmer. There are hexs, big and small, bar glitters, and her formula is pretty perfect. I wont buy another polish at the new $20 and up eBay price, but let's ignore that for now!
The second would be a lilac purple, like Sally Hansen Lacey Lilac, for obvious reasons ;)
The third would probably be a pale mint color, like Orly Ancient Jade. Soo pretty!
2. How often do your paint your nails?
Pretty much every 2-3 days! I dont mean to do it as much but if they chip, I will bite them which is baaaad. I am an ex-biter so they've got to be looking pretty much perfect for me to leave them alone.
Plus, since I teach, I try to keep my makeup neutral so my nails get to be wild!
3. What's the strangest thing you've ever eaten?
When I was 13, I traveled to Austria with my aunt, her boyfriend at the time, and his niece. I ordered a salmon and pesto pizza on flatbread (no marinara sauce). It was amazing but odd!
4. What's your favorite nail trend?
Pastels! I love soft spring-time looks.
5. Least favorite?
Tactile manicures like the microbeads and now the velvet manicure. The cutest version I've seen was an "Astroturf" mani w/little football players, LOL. I can't do the tactile stuff, I would just be picking at it or touching it and I'd never ever get anything done.
6. Zombies or unicorns?
Unicorns all the way. Soft, fuzzy, happy, pastel, ponies. My Little Pony's were my favorite thing ever - I'm a child of the 1980's!!
7. What's your favorite nail polish brand?
For mainstream brands, I vote China Glaze and I've recently come to this conclusion. I love the coverage and colors.
For indie brands, I'd say Rainbow Honey. I only have two now (with two from the Sakura Collection on the way!!) and I love the uniqueness. Pahlish is a close second!
8. What is the most you've ever paid for a bottle of polish?
9. What's the nail design you're most proud of?
I am not much of an artist! :)
10. What nail design did you try out that totally flopped?
I tried a galaxy manicure with a pink base which totally ruined the point! LOL.
11. What do you like to do other than blogging and nail polish?
I don't have time for much else b/c of school! I work, I teach history, I research history, I play with my dogs, spend time with my boyfriend, I love traveling especially to see my family in Connecticut, I love photography.
YOUR Questions:
1. How do you organize your stash?
2. If there was a fire, and your family was all safe, what 5 polishes are you rescuing?
3. When did you start loving makeup/polish/beauty products?
4. Describe your personal style.
5. One word that people that know you well would use to describe you.
6. Where is the weirdest place you ever polished your nails?
7. Do you have any other hobbies besides nail polish?
8. What is your favorite wild animal?
9. When and why did you start blogging?
10. How many bottles of polish do you own?
11. What do your friends / family think of your hobby?
The eleven bloggers I chose:
4. Tomboy Nails
Thanks for reading!!
- Muffin


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Our Team
Rod Lockard
Director of Construction Services
Rod has more than 35 years of experience in the general construction industry and more than 10 years of experience in the self storage construction industry. As Director of Construction Services, Rod can assist you with everything you need to get your construction project off the ground.
Matt DePrato
Senior Project Manager
With more than 10 years of experience in project management and self storage operations, Matt understands what owners need in today's construction world. His experience in operations brings a level of care that all storage owners and operators can appreciate.
Nate Jones
Project Manager
Mr. Jones has been working in project management for more than 10 years and has overseen all types of construction including residential remodeling and commercial projects.
Scott Forry, CPA
Vice President
No stranger to construction, Scott keeps all things financial tied together for Storage Construction. He has more than 15 years of experience in all things finance and accounting and robust knowledge of the construction industry.
Mike Rhoads
Mike is a leader in the self storage industry and has more than 30 years of experience in accounting, self storage operations, and development.