Claims

Conditional Payment Updates | Open Debt Reports are back; Pre-PCN worksheets are on hold; and CRC will continue to review all CPL disputes

There has been a flurry of recent activity from the Centers for Medicare and Medicaid Services (CMS) and the Commercial Repayment Center (CRC) regarding processing of conditional payment claims.  The new CMS and CRC...

South Carolina court: Medicare Advantage Plan can sue for “double damages” under the Medicare Secondary Payer statute

The South Carolina District Court is the latest jurisdiction presented with the question of whether a Medicare Advantage Plan (MAP) can sue for “double damages” under the Medicare Secondary Payer’s (MSP’s) private cau...

The new indemnity data call – are you ready?

As the fourth quarter settles in, a big change is lurking around the corner: The National Council on Compensation Insurance’s (NCCI) new indemnity data call.  Introduced last year, this initiative is scheduled to laun...

Seventh Circuit bypasses Medicare Advantage “double damages” question

The latest case addressing whether the Medicare Secondary Payer’s (MSP) private cause of action (PCA) statute [1] applies to Medicare Advantage Plans (MAP), thereby allowing MAPs to sue for double damages,” reached th...

Release of proposed “future medicals” rules will be delayed

New notice pushes back release date to October and makes other changes The Centers for Medicare and Medicaid Services’ (CMS) much anticipated release of proposed rules to address “future medicals” in relation to...

Massachusetts court: Medicare Advantage Plan’s assignee can sue for “double damages” under the MSP

In an interesting new case out of Massachusetts, the United States District Court in MSP Recovery Claims Series LLC v. Plymouth Rock Assurance Corporation , 2019 WL 3239277 (D. Massachusetts, July 18, 2019) found that...

PAID Act Introduced in the U.S. Senate

On June 26, 2019, Senators Tim Scott (R-SC) and Ben Cardin (D-MD) introduced Senate Bill 1989 into the U.S. Senate. Section one of this bill states the Act may be cited as the Provide Accurate Information Directly (PA...

With Civil Money Penalties Looming, It’s Time to Fine-Tune CMS Reporting

For insurance carriers and self-insureds—known as Responsible Reporting Entities (RREs)—Section 111 can be a daunting obligation. In fact, it’s the only Medicare Secondary Payer (MSP) compliance area associated with a...

Reality Check: Debunking the Myths of Medicare Secondary Payer Compliance

Medicare Secondary Payer (MSP) is a challenging area of compliance for which federal law, regulations, and policy don’t always provide clear answers. This often conflicts with the processes and procedures outlined by...

Longshore Act - Medicare Alert: Court Rules that Claimant’s Action for “Double Damages” Was Premature

An interesting new case out of California is a reminder that payers of claims pursuant to the Longshore and Harbor Workers’ Compensation Act (“Longshore Act”) need to stay vigilant for potential “double damages” actio...