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22
Oct 2019

Dealing with Drugs in the Medicare Set-Aside

By Rasa Fumagalli     

  The prescription component of a Medicare Set-Aside allocation may at times present an obstacle to the settlement of the claim. There are however certain steps which may be taken during the life of a claim to help ensure the lowest possible prescription allocation. This article will provide background on the drug pricing structure in
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22
Oct 2019

The Importance of Using Accurate Diagnosis Codes in Section 111 Reports

By Joseph Gregorio     

  In 2015, CMS announced it would be requiring responsible reporting entities (RREs) to begin using ICD-10 diagnosis codes in Section 111 reports for accidents occurring on or after October 1, 2015.  There are several benefits to using ICD-10 codes compared to ICD-9 codes, namely improved specificity and hierarchy of diagnoses.  Although ICD-10 codes are
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15
Oct 2019

Injurious Practices & The Illinois Workers’ Compensation Act

By Deidre Christenson     

  When can an employer deny benefits to an employee who has engaged in unhealthy behavior that has impacted his recovery? Section 19(d) of the Illinois Workers’ Compensation Act provides that: If any employee shall persist in insanitary or injurious practices which tend to either imperil or retard his recovery or shall refuse to submit
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09
Oct 2019

The “Eggshell Skull Rule” and Co-Morbidities

By Padraig McCoid     

  The “Eggshell Skull Rule” is a longstanding principle in workers’ compensation law.  Under the rule, you take an injured worker as you find him.  In other words, even if an accident would not have injured an average person, the employer may still be liable.  This is true with any co-morbidity an injured worker might
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06
Oct 2019

CMS To Grant Access to Open Debt Reports and Introduce New WCMSA Electronic Attestation Feature on the WCMSAP

By Paul Pasche     

  The Centers for Medicare and Medicaid Services (CMS) made two welcome announcements today that impact the Medicare Secondary Payer compliance community. Beginning on October 7, 2019, CMS will offer new access to Open Debt Reports through the CMS web portal designated for disputing and resolving Medicare conditional payments claims. An Open Debt Report will
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