Compliance

Top 10 Medicare Secondary Payer Trends in 2019

Medicare Secondary Payer (MSP) compliance is a rapidly evolving area that has experienced significant changes in recent years, and 2019 looks to be no different. Policy changes, stricter regulation...

CMS Releases New WCMSA Reference Guide (Version 2.9)

The Centers for Medicare and Medicaid Services (CMS) has just released their latest version of the WCMSA reference guide Version 2.9 (January 4, 2019) . These new updates include the following:...

CMS Releases New NGHP Section 111 User Guide

The Centers for Medicare and Medicaid Services (CMS) has updated its  Non-Group Health Plan (NGHP) Section 111 User Guide . The new guide is styled as Version 5.5 and is dated January 7, 2019. Per...

Government Shutdown – MSP Update

As the partial government shutdown continues, questions are being raised as to the shutdown’s impact on the Centers for Medicare and Medicaid Services (CMS) activities concerning Medicare Secondary...

Millennial impact: Preparing for the generational shift in workers’ comp

Workplace demographics are rapidly changing, and if insurers don’t prepare, they’ll face significant challenges. Millennials will make up 75 percent of the workforce by 2025. [1] For insurers, this...

Law Firm Reaches Settlement with U.S. Department of Justice to Reimburse Medicare Conditional Payments and Start Internal MSP Compliance Program

The United States Department of Justice (DOJ) for the Eastern District of Pennsylvania has issued a news release reporting that a Philadelphia personal injury law firm has agreed to pay the...

Analyze This: Why workers’ comp data gives insurers a strategic advantage

Data analytics has become a key driver in the development of business strategy for leading corporations, and workers’ compensation insurers are uniquely positioned to take advantage of this trend....

CMS Issues New Regulations Aimed at Identifying and Limiting Potential Opioid Abuse

On April 2, 2018, the Centers for Medicare and Medicaid Services (CMS) issued a final rule which updated regulations for Medicare Advantage Plans (MAP) and Medicare Part D programs. The primary foc...

Proactive data management key to handling EDI reporting challenges

Whenever there are changes to industry regulations or compliance standards, there’s always a degree of uncertainty about how they’ll affect insurers. But when IAIABC published its newest standard f...

Texas Court: Medicare Advantage Plans Can Sue for Private Cause of Action under the Medicare Secondary Payer Statute

In Humana v. Shrader , 2018 WL 1384529 (S.D. Tex. March 16, 2018), the federal district court ruled, in part, that the private cause of action (PCA) provision under the Medicare Secondary Payer (MS...