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Through an integrated medical, pharmacy, claims and legal approach, we deliver insights to help navigate the ever‑changing Medicare Secondary Payer landscape.

Recent blog posts

May 05, 2021 · Medicare Insights Team
The Centers for Medicare and Medicaid Services (CMS) released Version 3.3 of the Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide, which clarifies how to calculate the seed money (initial deposit) in a structured WCMSA. Read more...
April 28, 2021 · Medicare Insights Team
The generic of Hysingla ER, hydrocodone bitartrate extended-release (ER) tablets, was released in March 2021 and became available for allocation in Workers’ Compensation Medicare Set-Asides (WCMSAs) as of early April 2021. Read more...
April 13, 2021 · Medicare Insights Team
Optum continually monitors the average wholesale price (AWP) of the most common medications in Workers’ Compensation Medicare Set-Asides (WCMSAs) to help our clients properly assess their WCMSA exposure and achieve the lowest possible allocations. Read more...
March 01, 2021 · Medicare Insights Team
Over 800 brand-name medications increased in price in January 2021 ― below we list price boosts for 19 of these medications commonly seen in Workers’ Comp Medicare Set Aside Arrangements (WCMSAs), which average a 6% cost increase. Read more...
February 10, 2021 · Medicare Insights Team
A lower price is now available for a common workers’ compensation medication as its brand alternative hit store shelves in January. Amitiza® is approved by the U.S. Food and Drug Administration (FDA). Read more...
January 06, 2021 · Settlement Solutions Team
To help our clients achieve the lowest possible Workers’ Compensation Medicare Set-Aside (WCMSA) allocations, Optum continually monitors the average wholesale price (AWP) of the most common medications seen in a WCMSA. The following outlines the most recent price decreases for a few of these medications. Read more...
December 21, 2020 · Lavonya Chapman, Associate General Counsel of Optum Settlement Solutions
The recently enacted Provide Accurate Information Directly (PAID) Act will make it easier to determine whether payments for claimed injuries/illness involving workers’ compensation, no-fault and/or liability claims were made by traditional Medicare and/or a Medicare Advantage (Part C) plan (MAP) and/or a prescription Part D plan (PDP) and whether they need to be reimbursed. Read more...
December 07, 2020 · Lavonya Chapman, Esq, RN, CMSP, Associate General Counsel, Optum Settlement Solutions
On November 12, 2020, the Centers for Medicare and Medicaid Services (CMS) issued a Technical Alert and published version 6.1 of the Non-Group Health Plan (NGHP) Section 111 User Guide. Both note changes that will eventually impact Civil Money Penalties (CMP) involving Section 111 reporting when CMS error tolerance thresholds are exceeded. Read more...
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