VISUALIZE | INSIGHTS THAT POWER INNOVATION

Mark Popolizio

Mark Popolizio, J.D., is vice president of MSP compliance at ISO Claims Partners, a Verisk business. You can contact Mark at mpopolizio@verisk.com.

Amy Hirschi Szrj3wjzomg Unsplash
January 22, 2021

CMS releases new NGHP Section 111 User Guide (Version 6.2, January 11, 2021)

CMS has released an updated Section 111 NGHP User Guide (Version 6.2, January 11, 2021) regarding non-group health plans (liability, no-fault, and workers’ compensation).

Imageavbb2
January 11, 2021

The PAID Act is now law

In a major development on the Medicare Secondary Payer (MSP) compliance front, on December 11th, President Trump signed into law the Provide Accurate Information Directly…

Markus Frieauff Ij0kixl4uys Unsplash 1
December 16, 2020

LMSA update: CMS’s “future medicals” proposals now scheduled for release in March 2021 | New LMSA case decision highlights continuing claims challenges

LMSA update: OIRA has issued an updated noticing indicating CMS’s “future medical” proposals are delayed again and projected for release in March 2021.

Kelly Sikkema Sbxdmooy9zm Unsplash 1
December 14, 2020

The PAID Act is now law

On 12/11, the PAID Act became law. It requires CMS expand its Section 111 Query Process to identify whether a claimant is currently entitled to, or during the preceding…

National Cancer Institute L8twzt4ccvq Unsplash
December 7, 2020

New case highlights how LMSA issues and questions continue to complicate liability claim settlements

In Abate V. Wal-Mart Stores East, L.P. the court found CMS’s 9/30/11 memo didn’t mandate the plaintiff get a letter from her doctor certifying treatment was completed or…

Image7oepl
November 30, 2020

CMS retains $750 low dollar threshold for 2021

CMS has announced it is retaining its current $750 low dollar threshold for 2021.

Markus Spiske Risajgsa0vg Unsplash
November 13, 2020

CMS releases new NGHP Section 111 User Guide (Version 6.1) and Technical Alert

CMS’ recently released NGHP Section 111 User Guide and Technical alert outline the eventually elimination of the ‘SP31’ error notices and updates to the “soft error”…

Jeshoots Com Puam5hpacri Unsplash
November 10, 2020

CMS NGHP Beneficiary Recovery Process webinar December 9th

CMS has released a notice announcing that it will be holding a Non-Group Health Plan (NGHP) Beneficiary Recovery Process webinar on December 9, 2020, at 1:00 p.m. ET.

Omer Shahzad Cjlgqrhk7di Unsplash
September 10, 2020

11th Circuit rules Medicare Advantage downstream entities can sue for double damages under MSP’s PCA provision

The 11th Circuit has ruled “downstream entities”, which Medicare Advantage Plans contract with to help provide benefits, can sue primary plans for “double damages.”

Martha Dominguez De Gouveia K Nnvz Z26w Unsplash
August 25, 2020

U.S. Department of Justice and plaintiff law firm reached a settlement to resolve a Medicare conditional payment claim

The DOJ’s Attorney’s Office for the Middle District of Pennsylvania has settled a Medicare conditional payment claim with the plaintiff law firm.

Harold Mendoza 6xafy Ae1lm Unsplash
August 20, 2020

What’s up in D.C.? Medicare Secondary Payer reform efforts – status update

With the current Congressional session ending on 1/3/21, attention is on two pending Medicare Secondary Payer reform efforts: The PAID Act & the COMP Act.

Gabrielle Henderson Hjckknwcxxq Unsplash
August 17, 2020

CMS to host CRC NGHP Applicable Plans webinar on September 24th

CMS released a notice announcing they’ll be holding a webinar on the CRC NGHP Applicable Plans Appeals Webinar on September 24, 2020, at 1:00 p.m. ET.

Ali Yahya U449w1ryvzq Unsplash
August 11, 2020

OIRA releases updated information Section 111 CMPs

OIRA released an updated notice on the status of CMS’s Section 111 civil money penalties proposals. CMS released the proposals in February 2020 and opened a public…

Nathalia Rosa Rwmibqmoxry Unsplash
August 7, 2020

Connecticut court rules Medicare Advantage Plan entitled to double damages

The U.S. District Court for Connecticut in Aetna v. Guerrera, 2020 ruled, in part, the alleged self-insured supermarket was a primary plan and liable for “double damages”…

Dan Farrell Fnr2u1lxsbq Unsplash
July 15, 2020

CMS to hold Section 111 NGHP webinar on August 13th

CMS has released a notice announcing it will be holding a webinar for Section 111 non-group health plan reporting on August 13, 2020, at 1:00 p.m. EDT.