Mark Popolizio
Government shutdown ends – Congress and President reach deal
This brief government shutdown did not affect Medicare Secondary Payer operations as they are essential and considered part of the Medicare Integrity Program. Thus,…
Medicare Advantage Plans update: Illinois court indicates MAPs have “double damages” rights
Whether Medicare Advantage Plans have private cause of action rights to sue claims payers (and others) for “double damages” under the Medicare Secondary Payer (MSP)…
CMS Releases New Section 111 NGHP User Guide (Version 5.3)
The Centers for Medicare and Medicaid Services (CMS) has released an updated Section 111 non-group health plan (NGHP) User Guide (Version 5.3, December 15, 2017). This…
CMS maintains its $750 low dollar threshold for 2018
CMS has announced that it is maintaining the current $750.00 low dollar threshold in 2018 for certain settlement, judgments, awards or other payments.
Court declines to rule on whether LMSA is necessary - Cites no legal authority for MSAs in liability cases
Whether liability Medicare set-asides (LMSAs) are legally “required” continues to be a vexing question for parties settling liability claims.
Liability MSA update
On October 26, 2017, the Centers for Medicare and Medicaid Services (CMS) has released its latest update regarding the LMSA issue.
Countdown to “full and final” settlements: Arizona S.B. 1332
The recent passage of Arizona Senate Bill (S.B.) 1332 provides Arizona claims payers with unprecedented opportunity to close out their workers' comp claims.
Court blocks Medicare discovery requests - Ruling limits insurer's ability to determine MMSEA obligations
A new case out of Connecticut highlights complications insurers can encounter in obtaining information to assess their MSP compliance obligations.
New realities: The Section 111 connection to conditional payments and claim outcomes
Section 111 reporting used to be viewed as an abstract technical Medicare compliance obligation & IT's responsibility because of the data transmission.
Exhaust administrative remedies before challenging Medicare conditional payment claims
When challenging Medicare conditional payment claims, parties must exhaust Medicare administrative appeals before filing an action in federal court.
2017 Medicare watch list
It’s clear there will be no shortage of Medicare Secondary Payer developments to keep an eye on this year. Here’s an outline of MSP events to watch in 2017.
New development hints at future MSA expansion to liability: CMS updates Common Working File for LMSAs and NFMSAs
CMS has issued a Change Request (CR-9893) to update it's Common Working File regarding both Liability and No-Fault Medicare Set-Aside arrangements.
Breaking: CMS recovery practice ruled improper under the MSP
In CIGA v. Burwell, the court ruled the CMS practice of seeking full reimbursement of a medical provider's single charge was improper under the MSP statute.
CMS releases updated reporting and recovery thresholds with news on TPOCs
The Centers for Medicare and Medicaid Services (CMS) has released its latest alert regarding its low-dollar reporting and recovery thresholds pertaining to liability…
New report reveals Medicare’s “low-dollar” threshold calculations
Medicare calculated its recently revised “low-dollar” recovery and reporting thresholds for liability, workers compensation and no-fault settlements.