ISO Claims Partners

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...

Big reforms are coming to Michigan PIP - How the changes will impact Medicare Secondary Payer compliance

On May 30, 2019, Michigan Governor Gretchen Whitmer signed into law Michigan Senate Bill 1 (S.B. 1) [1] which makes significant changes to Michigan’s personal injury protection (PIP) system, including allowing policy...

Florida court: No-fault pre-suit notice requirement must be followed before Medicare private cause of action claim can proceed

Over the past several years, there has been an increasing number of lawsuits filed by Medicare Advantage Plans (MAPs) against insurers seeking “double damages” under the Medicare Secondary Payer (MSP) statute’s privat...

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...