Mark Popolizio
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).
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…
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.
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…
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…
CMS retains $750 low dollar threshold for 2021
CMS has announced it is retaining its current $750 low dollar threshold for 2021.
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”…
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.
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.”
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.
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.
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.
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…
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”…
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.