Court Blocks Medicare Discovery Requests – Ruling limits insurer’s ability to determine MMSEA obligations

A new case out of Connecticut highlights complications insurers can encounter in obtaining information to assess their Medicare Secondary Payer (MSP) compliance obligations. In Silver v. Milford Medical Center Associates, 2017 WL 2452551 (Conn. Super. Ct. May 11, 2017), the court denied the defendant’s motion to file supplemental discovery requests to procure Medicare related information. […]

Fact Check Time for LMSA/NFMSA Developments

It is no secret that CMS has announced (for years) its intention to expand the workers’ compensation MSA program into the liability and no-fault arena. But the real question today is: What, when, and how is CMS going to step into this new arena and how will it affect claims management? CMS has provided little […]

New Realities: The Section 111 Connection to Conditional Payments and Claim Outcomes

Section 111 reporting historically has been viewed as an abstract technical Medicare compliance obligation and the responsibility of an IT department, because it involves the electronic transmission of data to Medicare. In the last year and a half, however, the situation has changed. What’s Changed Now, the Commercial Repayment Center’s (CRC) recovery for conditional payments […]

Risky Business: Five Essential Tips for Section 111 Reporting

Your Section 111 reporting program may seem clear-cut, but it can mean risky business if your team isn’t prepared to avoid the pitfalls of common compliance mistakes. The primary objective of Section 111 reporting is to alert Medicare to bodily injury claims involving Medicare beneficiaries. This sets the course for Medicare to track claim-related payments […]

Surprising Trends in Auto Claims Frequency and Severity

Indications are Americans will drive more but crash less—welcome news. Yet despite the decrease in the number of accident claims, auto insurance loss costs are mounting. That’s because claim severity is increasing at a rate that’s outpacing the decline in claims frequency. A number of factors are contributing to losses, and we’re looking at how […]

New Ruling: Court Expands upon Its Recent Ruling Limiting CMS Recovery Rights

The court in CIGA v. Price, 2017 WL 1737717 (C.D. California, May 3, 2017) has expanded upon its prior order limiting Medicare’s conditional payment rights. The case has garnered much industry attention, given its potential impact on the Centers for Medicare & Medicaid Services (CMS) recovery claims. The Case In this action, CIGA challenged CMS’ […]