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Sharing perspectives leads to greater understanding and fuels innovation. The ​Optum Insights ​blog is where we share our perspective and challenge preconceptions to clear a new path forward



  • California Insurance Guarantee Association is not a primary payer under Medicare

    by
    • Rafael Gonzalez Esq. President Optum Settlement Solutions
    | Nov 22, 2019
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    Medicare Insights, Medicare Set-Aside, MSA
    On October 10, 2019, the United States Court of Appeals for the Ninth Circuit published its opinion on California Insurance Guarantee Association v. Azar, concluding that CIGA is not a primary plan under the Medicare secondary payer provisions, but an insurer of last resort, therefore, is under no obligation to reimburse CMS for conditional payments made on behalf of workers’ compensation insureds.


  • CMS announces accessibility to Open Debt Reports

    by
    • Rafael Gonzalez
    | Nov 20, 2019
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    Medicare Set-Aside, MSA, Medicare Secondary Payer, MSPA Claims, CMS
    The Centers for Medicare and Medicaid Services (CMS) recently published Version 4.7 of the Medicare Secondary Payer Recovery Portal (MSPRP) User Guide. A notable update in this version is accessibility to Open Debt Reports for account managers. As stated in the user guide, the Open Debt Report page displays the status of open debts with account receivable balances greater than zero.


  • Lots of Changes in CMS’ Latest WCMSA Reference Guide

    by
    • Rafael Gonzalez
    | Nov 07, 2019
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    Side Effects, Medicare Insights, medicareinsights blog, CMS, WCMSA
    On October 10, 2019, the Centers for Medicare and Medicaid Services (CMS) published its latest Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide.


  • How comorbid respiratory diseases & smoking impact injured claimant outcomes: Part four

    by
    • Clinical Connection team
    | Oct 31, 2019
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    Clinical Intervention, Comorbidities, comorbidity
    Respiratory health is an important but often overlooked component of a person’s overall health and well-being. Respiratory issues not only can worsen an injured person’s prognosis, but can increase the risk of adverse health effects in some working environments.


  • Comorbid High Blood Pressure in the Injured Individual: Part three

    by
    • Clinical Connection team
    | Oct 23, 2019
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    Workers' Compensation, workers compensation, Clinical, Chronic Pain, Comorbidities
    Part three of our series discusses how injuries can often lead to comorbidity and complications that can lengthen the duration of treatment, delay return to work and increase costs.


  • Comorbid Mental Health Disorders in Workers’ Compensation & Auto No-fault: Part two

    by
    • Clinical Connection team
    | Oct 17, 2019
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    Auto No-Fault, Workers' Compensation, mental health, comorbidity, Comorbidities
    Comorbid mental health issues can lengthen return-to-work times and increase costs in workers' comp and auto no-fault. Learn about the impact of mental health comorbidity and what steps to take to mitigate its effect.


  • Comorbidity and Injured Individuals: Part one

    by
    • Clinical Connection team
    • Medicare Insights
    | Oct 09, 2019
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    MSA, Medicare Set-Aside, Medicare Insights, Comorbidities, clinical info, Clinical
    Comorbid conditions in workers’ compensation and auto no-fault can create a trifecta of negative outcomes and aggravate an already difficult situation for an injured individual. In Part one of our series on comorbidities, we will define what they are and describe the three ways comorbidities can make a bad situation worse.



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