Centers for Medicare and Medicaid Services (CMS)

CMS holds town hall call to discuss NGHP conditional payment recovery issues

On January 14, 2020, the Centers for Medicare and Medicaid Services (CMS) held its widely anticipated town hall call to discuss recovery issues related to the Commercial Repayment Center (CRC) and on-going...

Where are we with CMS’s Section 111 penalty and future medicals proposals?

With 2020 quickly settling in, attention will likely focus back on the Centers for Medicare and Medicaid Services’ (CMS) widely anticipated release of its Section 111 civil money penalties (CMPs) and future medicals...

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...

Workers’ Compensation Medicare Set Aside Legislation Filed, Referred to Committee

On June 18, 2018, Senators Rob Portman (R-OH) and Bill Nelson (D-FL) introduced legislation aimed at reforming the Centers for Medicare and Medicaid Services’ (CMS) Workers’ Compensation Medicare Set-Aside (WCMSA)...

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 of the United States...

Deep Dive: Clinical Trials and Section 111 Reporting

ISO Claims Partners is dedicated to demystifying Section 111. Today I’d like to take a deep dive into one reporting trigger of Ongoing Responsibility for Medicals (ORM) by exploring clinical trials. Created by CMS...

Medicare Conditional Payment Compliance: Myth vs. Fact

The statutes and regulations that govern Medicare have been referred to by courts as “ the most completely impenetrable texts within human experience .” With the complex nature of Medicare compliance comes the resulti...