Mark Popolizio, J.D.
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.
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 releases updated Medicare Secondary Payer Recovery Portal (MSPRP) user guide (Version 4.9)
CMS has released an updated Medicare Secondary Payer Recovery Portal User Guide (Version 4.9, July 13, 2020). CMS has made multiple updates to the MSPRP, which the agency…
Seven steps to closed: Maximizing claims settlement projects
There's a thin and potentially costly line between settling a claim and keeping it open. Using a claims settlement project can help close claims faster.
Eleventh Circuit rules that Florida Medicaid may seek recovery of its past payments from those portions of the settlement agreement representing past and future medical care
In a new Florida Medicaid decision, the U.S. Circuit Court of Appeals for the Eleventh Circuit, in Gallardo v. Dudek, 2020 ruled Florida Medicaid may seek recovery of…
CMS releases new NGHP Section 111 User Guide (Version 5.9)
CMS has released an updated Section 111 NGHP User Guide (Version 5.9, June 29, 2020) regarding non-group health plans (liability, no-fault and workers’ compensation).
CMS’s expected release of its “future medicals” proposals now scheduled for August 2020
An updated notice from the Office of Information and Regulatory Affairs indicates CMS’s long-anticipated release of its “future medicals” notice of proposed rulemaking is…
Key changes to Michigan PIP start July 1, 2020 – Medicare Secondary Payer compliance impact
While individuals will still be able to elect unlimited PIP coverage, for applicable policies issued or renewed after 7/1/20, PIP plans with different coverage limits may…
CMS releases Section 111 alert regarding the reporting of no-fault insurance and med-pay policy limits on claim input files
Limits on NGHP claim input files in situations where separate Med-Pay and PIP coverages being paid out under a single policy for the same injured party and incident.