Centers for Medicare & Medicaid Services (CMS)
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).
CMS holds NGHP beneficiary recovery process webinar
On 12/9, CMS held a non-group health plan beneficiary recovery process webinar aimed at attorneys who represent beneficiaries and other beneficiary representatives.
PAID Act passes House, moves to the Senate
The House of Representatives passed the PAID Act as a stand-alone bill and as part of the BENES Act of 2019. Both bills now move to the Senate for further consideration.
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”…
Medicare conditional payment round-up
CMS has been quite active this year announcing several updates to its Medicare Secondary Payer Recovery Portal and holding a recent webinar on redetermination requests
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.
Court finds state of Rhode Island compliant with Section 111 despite its inability to obtain social security information to determine Medicare status and enforces settlement
The U.S. District Court in Ruiz v. Rhode Island was called upon to address whether a personal injury settlement should be enforced even though the defendant was unable to…
Settling claims in unsettling times
In a time of social distancing and uncertainty, many are left wondering how our current working and social paradigm will impact workers’ compensation claims handling –…
Liability Medicare Set Asides – Bracing for the storm
Liability claims payers have been left to navigate the uncertainties around LMSA’s the best they can while preparing for where CMS may be heading next.
CRC looks to resolve backload of conditional payment leads
On 8/9/19, the Commercial Repayment Center hosted a conference call to discuss the handling of conditional payment letters versus conditional payment notices.
WCMSA RX update – FDA approves first generics of Lyrica
On 7/22/19, the FDA announced it approved the first generics of Lyrica. This comes at a critical time as CMS has increasingly been including Lyrica in WCMSAs
Massachusetts court: Medicare Advantage Plan’s assignee can sue for “double damages” under the MSP
Massachusetts is the latest jurisdiction to take a favorable view of MAPs possessing private cause of action rights under the Medicare Secondary Payer.
Think about your thresholds: Preventing errors to avoid CMS penalties
One way responsible reporting entities can attempt to achieve full CMS compliance and avoid potential penalties is to closely consider file thresholds.