Centers for Medicare and Medicaid Services (CMS)

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...

PAID Act Introduced in the U.S. Senate

On June 26, 2019, Senators Tim Scott (R-SC) and Ben Cardin (D-MD) introduced Senate Bill 1989 into the U.S. Senate. Section one of this bill states the Act may be cited as the Provide Accurate Information Directly (PA...

Medicaid Expansion Makes Recovery Efforts More Urgent

Created in 1965 to provide health care coverage to low-income individuals, Medicaid is now a massive program that provides insurance to one out of five Americans, including adults, children, pregnant women, the elderl...

Think about Your Thresholds: Preventing Errors to Avoid CMS Penalties

We’ve been taking a look at some of the ways RREs can attempt to achieve full CMS compliance and avoid potential penalties that may be coming soon. One area to consider more closely is file thresholds. Upon submission...

Avoiding Penalty Problems by Ensuring Data Accuracy

With CMS (Centers for Medicare and Medicaid Services) penalties on the horizon, we’ve been exploring how RREs (Responsible Reporting Entities) can be proactive in avoiding fines. We covered timely reporting in our...

To Avoid CMS Penalty Exposure Time Is of the Essence

The timely reporting of ORM (Ongoing Responsibility for Medicals) and TPOC (Total Payment Obligation to Claimant) data to the Centers for Medicare and Medicaid Services (CMS) is of key importance to insurers, especial...

Georgia Senate Bill 135 Adds Exceptions to the 400 Week Limit for Future Medicals – Overview and WCMSA Impact

Georgia Senate Bill 135 (SB 135) was signed into law on May 7, 2019 and makes notable changes to Chapter 9 of Title 34 of the Official Code of Georgia Annotated related to workers’ compensation. These new changes will...

With Civil Money Penalties Looming, It’s Time to Fine-Tune CMS Reporting

For insurance carriers and self-insureds—known as Responsible Reporting Entities (RREs)—Section 111 can be a daunting obligation. In fact, it’s the only Medicare Secondary Payer (MSP) compliance area associated with a...