Centers for Medicare and Medicaid Services (CMS)

Ninth Circuit: CIGA is not a “primary payer” under the MSP and does not have to reimburse Medicare

In a significant new case out of California, the United States Circuit Court of Appeals (Ninth Circuit) [1] in California Insurance Guarantee Association (CIGA) v. Azar , 2019 WL 5076945 (9 th Cir. Oct. 10, 2019)...

CMS Releases WCMSA Portal User Guide Version 5.9

The Centers for Medicare and Medicaid Services (CMS) has released the latest edition of its Workers’ Compensation Medicare Set-Aside Portal User Guide (WCMSAP) (Version 5.9; October 7, 2019). CMS outlines its full lis...

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...

CMS’ Section 111 Penalty Proposals Are One Step Closer

A new release from the Office of Information and Regulatory Affairs (OIRA) indicates that the Centers for Medicare and Medicaid Services (CMS) is one step closer to releasing its much-anticipated Section 111 reporting...

CMS Will Use the 2016 CDC Life Table for WCMSAs Starting 10/12/19

In an alert dated September 12, 2019, the Centers for Medicare and Medicaid Services (CMS) announced that beginning October 12, 2019, it will use the new 2016 CDC Life Table to calculate adjusted life expectancies in...

Proposed Workers’ Compensation Medicare Set Aside Reform Bill Filed in the U.S. House of Representatives

On August 2, 2019, Representatives Mike Thomson (D-CA) and George Holding (R-NC) introduced legislation aimed at reforming the Centers for Medicare and Medicaid Services’ (CMS) Workers’ Compensation Medicare Set-Aside...

CRC looks to resolve backload of conditional payment leads

On August 9, 2019, the Commercial Repayment Center (CRC) hosted a conference call to discuss the handling of conditional payment letters (CPL) versus conditional payment notices (CPN). On this call, the CRC announced...

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...

WCMSA RX Update – FDA approves first generics of Lyrica

In a July 22, 2019 news release , the Food and Drug Administration (FDA) announced that it has approved the first generics of Lyrica. This announcement comes at a critical time as the Centers for Medicare and Medicaid...

CMS releases new NGHP Section 111 User Guide (Version 5.6)

The Centers for Medicare and Medicaid Services (CMS) has released an updated Section 111 User Guide (Version 5.6, July 1, 2019 ) regarding non-group health plans (liability, no-fault and workers’ compensation). This...