Compliance

Budget Act of 2018 Limits Medicaid Third-Party Recovery Rights

President Trump signed a budget deal early February 9 th following a brief government shutdown while most Americans were fast asleep. While most of the headlines focused on the deal’s impact on...

CRC Transition Update: Temporary Halt on Recovery Activities

On February 2, 2018, the Centers for Medicare and Medicaid (CMS) issued its latest update regarding the Commercial Repayment Center (CRC) transition from CGI Federal to Performant Financial...

CMS Holds Town Hall Call on CRC Transition - CMS Provides Important Updates on ORM Recovery Transition

On January 18, 2018, the Centers for Medicare and Medicaid (CMS) held its Commercial Repayment Center (CRC) Non-Group Health Plan (NGHP) Town Hall presentation to address the upcoming transition of...

Medicare Advantage Plans Update: Illinois Court Indicates MAPs Have “Double Damages” Rights

Whether Medicare Advantage Plans (MAPs) have private cause of action (PCA) rights to sue claims payers (and others) for “double damages” under the Medicare Secondary Payer (MSP) statute remains a...

CMS Schedules NGHP CRC Transition Webinar for January 18, 2018

The Centers for Medicare and Medicaid Services (CMS) will be holding a webinar on Thursday, January 18, 2018 at 1:00 PM ET to provide information and details related to the transition of the...

ISO ClaimSearch Will Partially Mask PII to SIU-level Users in Claims Inquiry

While data risk mitigation issues continue to emerge in our industry, ISO ClaimSearch is always working to maintain the privacy and security of claims data. So to safeguard personally identifiable...

CMS Extends CRC Transition to February 8, 2018

In October 2017, the Centers for Medicare and Medicaid Services (CMS) awarded the Commercial Repayment Center (CRC) contract to Performant Financial Corporation (Performant). The CRC is the...

CMS Releases New Section 111 NGHP User Guide (Version 5.3)

The Centers for Medicare and Medicaid Services (CMS) has released an updated Section 111 non-group health plan (NGHP) User Guide ( Version 5.3, December 15, 2017 ). This new User Guide replaces...

Medicare Part D - The Next Recovery Frontier?

Medicare Secondary Payer (MSP) compliance has historically focused on the interests of traditional Medicare (that is, Medicare Parts A and B). In the wake of the recent In Re Avandia decision out o...

The CMS WCMSA "Amended Review Process" New Opportunity to Reduce WCMSA Allocations and Settle Claims

For years, the Centers for Medicare and Medicaid Services (CMS) has refused to consider medical evidence postdating the original submission date of a Workers’ Compensation Medicare Set-Aside (WCMSA) proposal.