Claims

CMS to host Town Hall Meeting to discuss CRC ORM recovery issues related to NGHP claims

The Centers for Medicare and Medicaid Services (CMS) has announced that it will host a telephonic Town Hall meeting to discuss recovery issues related to the Commercial Repayment Center (CRC) and on-going responsibili...

Illinois court dismisses Medicare Advantage Plan suit for “double damages” on standing grounds

In MAO-MSO Recovery II, LLC v. State Farm , 2019 WL 6311987 (C.D. Ill. Nov. 25, 2019), [1] the United States District Court for the Central District of Illinois found that an assignee of a Medicare Advantage Plan (MAP...

CMS retains its $750 “Low Dollar” threshold for 2020

The Centers for Medicare and Medicaid Services (CMS) has released its low dollar recovery threshold for 2020 via a new alert . CMS is generally required to publish an annual low dollar threshold amount according to...

CMS’s expected release of its “future medicals” (LMSA) proposals delayed until February 2020

The Office of Information and Regulatory Affairs (OIRA) has issued an updated notice   indicating that the Centers for Medicare and Medicaid Services (CMS) expected release of its Notice of Proposed Rulemaking (NPRM)...

Release of CMS’s Section 111 penalty proposals delayed again – pushed back to December

The Office of Information and Regulatory Affairs (OIRA) has issued an updated notice indicating that the Centers for Medicare and Medicaid Services’ (CMS) expected release of its Notice of Proposed Rulemaking (NPRM)...

CMS’s new Section 111 Alert addresses MBI reporting

The Centers for Medicare and Medicaid Services (CMS) has issued an updated Section 111 Alert pertaining to non-group health claims (NGHP) regarding the Medicare Beneficiary Identifier (MBI) reporting.    Through CMS’s...

Litigation insights offer the key to rising claim costs

Insurers are constantly seeking ways to enhance efficiency and contain costs in claims operations. Sure, technology has helped streamline processes and reduce some expenses, but many carriers still struggle to manage...

All-or-Nothing Automation? Incremental Change Is a Winning Proposition

Until recent years, implementing automation improvements in insurance processes seemed a futuristic dream available only to carriers with the biggest IT and R&D budgets. Today, thanks to economies of scale brought to...

Liability Medicare Set Asides – Bracing for the Storm

For years, the Liability Medicare Set-Aside (LMSA) issue has been the source of much debate and frustration for liability claims payers. To date, there remain lingering questions on several fronts and the Centers for...

CMS releases new NGHP Section 111 User Guide (Version 5.7)

The Centers for Medicare and Medicaid Services (CMS) has released an updated  Section 111 User Guide (Version 5.7, October 7, 2019)   regarding non-group health plans (liability, no-fault and workers’ compensation)....