Centers for Medicare & Medicaid Services (CMS)

6/7/2023 - 20 min read

CMS releases Section 111 NGHP User Guide (Version 7.2, June 5, 2023) – new changes include: NGHP Unsolicited Response File, ORM reporting trigger, ORM termination, and HEW software

(CMS) has released an updated Section 111 NGHP User Guide regarding Section 111 reporting related to non-group health plans.

6/7/2023 - 8 min read

The RAMP Act is re-introduced in Congress – bill proposes revisions to the MSP’s private cause of action (“double damages”) provision

On 5/16/23, (RAMP) Act was re-introduced into the U.S. House of Representatives, bill proposes revisions to the MSP’s private cause of action provision.

Gavel on a white background with a small shadow.

5/23/2023 - 9 min read

The United States District Court for Massachusetts dismisses a Medicare Advantage claim for “double damages” – rules that insurer’s Section 111 reporting does not establish standing to sue

The U.S. District Court for Massachusetts dismisses Medicare Advantage claim for “double damages”—rules insurer’s Section 111 reporting doesn't establish standing to sue.

5/18/2023 - 4 min read

CMS releases the WCMSA Reference Guide Version 3.9

CMS has made various updates to different aspects of its WCMSA process, including removing the time limit on Amended Reviews.

5/16/2023 - 1 min read

CMS to hold a Section 111 Non-Group Health Plan (NGHP) Unsolicited Response File Webinar on Tuesday June 6, 2023

5/16/2023 - 15 min read

CMS’s NGHP Unsolicited Response File “opt-in” process starts in July 2023 – Q&A, issues, and considerations

Earlier this year (CMS) formally announced a new non-group health plan (NGHP) Unsolicited Response File “opt-in” feature. Per CMS, this new process starts “July 2023”

5/3/2023 - 6 min read

CMS releases Non-Group Health Plan (NGHP) Applicable Plan Appeals Reference Guide (Version 1.0)

The Centers for Medicare and Medicaid Services (CMS) has released a Non-Group Health Plan (NGHP) Applicable Appeals Reference Guide (Version 1.0, April 27, 2023).

5/1/2023 - 10 min read

CMS’s Query Process and non-binary/unspecified gender designations – current issues and considerations

Section 111 non-group health plan (RREs) involves the inability to submit non-binary or unspecified gender designations as part of the (CMS’s)

4/26/2023 - 1 min read

Starting April 29, 2023, CMS Will Use the 2020 CDC Life Table for WCMSAs

The (CMS) has announced that beginning April 29, 2023, it will use the new 2020 CDC Life Table to calculate adjusted life expectancies in (WCMSAs).

4/25/2023 - 3 min read

CMS releases Section 111 NGHP User Guide (Version 7.1, April 24, 2023)

The Centers for Medicare and Medicaid Services (CMS) has released an updated Section 111 NGHP User Guide (Version 7.1, April 24, 2023)

3/21/2023 - 25 min read

Waiting for CMS’s Section 111 penalties “final rule” – status, updates, and what’s next

Presently, the industry is waiting for CMS to release its Section 111 CMPs “final rule” to the public.

3/17/2023 - 1 min read

Medicare’s Commercial Repayment Center (CRC) updates mailing address for Non-Group Health Plan (NGHP) Medicare Secondary Payer (MSP) correspondence

2/22/2023 - 19 min read

CMS pushes back the timeline to release its Section 111 penalties “final rule” for one-year (until February 18, 2024)

In a major Section 111 development, (CMS) has extended the timeline to release its Section 111 civil money penalties (CMP) “final rule” until February 18, 2024.

2/7/2023 - 8 min read

CMS makes updates to Section 111 NGHP User Guide (Version 7.0) – updates relate to upcoming changes to the NGHP Unsolicited Response File

As reported in our recent article, in early January CMS released a new version of their Section 111 NGHP Section 111 User Guide (Version 7.0, January 9, 2023).

1/17/2023 - 6 min read

CMS releases updated Medicare Secondary Payer Recovery Portal (MSPRP) User Guide (Version 5.6) – Updates to Open Debt Report, Compromise Requests, and Go Paperless notifications

The Centers for Medicare and Medicaid Services (CMS) has released an updated Medicare Secondary Payer Recovery Portal (MSPRP) User Guide Version 5.6 (January 9, 2023).