Conditional Payments

1/19/2018 - 4 min read

CMS holds town hall call on CRC transition - CMS provides important updates on ORM recovery transition

On January 18, 2018, CMS held its Commercial Repayment Center Non-Group Health Plan (NGHP) Town Hall presentation to address the upcoming transition of CRC operations from CGI Federal to Performant Financial Corporation.

1/11/2018 - 1 min read

CMS schedules NGHP CRC transition webinar for January 18, 2018

The Centers for Medicare and Medicaid Services (CMS) will be holding a webinar on Thursday, January 18, 2018 at 1:00 PM ET to provide information and details related to the transition of the Commercial Repayment Center (CRC) contract to Performant Financial Corporation (Performant) effective February 8, 2018.

12/27/2017 - 1 min read

CMS extends CRC transition to February 8, 2018

The Centers for Medicare and Medicaid Services (CMS) is extending the Commercial Repayment Center (CRC) contract transition from CGI Federal to Performant Financial Corporation until February 8, 2018.

9/26/2017 - 6 min read

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.

8/2/2017 - 9 min read

Making sense of the WCMSA reference guide 2.6

On 7/31, CMS released their new WCMSA Reference Guide. Learn what the changes outlined might mean for submitting WCMSAs to CMS.

5/22/2017 - 4 min read

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.

5/17/2017 - 5 min read

Risky business: Five essential tips for Section 111 reporting

Your Section 111 reporting program may seem clear-cut, but it can mean risky business if your team isn’t prepared to avoid common compliance mistakes.

4/26/2017 - 4 min read

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.

1/10/2017 - 6 min read

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.

12/16/2016 - 2 min read

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 (including self-insurance), workers' compensation, and no-fault settlements, judgments, awards, or other payments (settlements).

11/14/2016 - 4 min read

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.

11/10/2016 - 1 min read

CMS to hold town hall call on November 17

The Centers for Medicare and Medicaid Services (CMS) will conduct a town hall teleconference November 17, 2016.

10/19/2016 - 4 min read

CMS updates Medicare Secondary Payer Recovery Portal

On October 11, 2016, the Centers for Medicare and Medicaid Services (CMS) released a new, updated version of the Medicare Secondary Payer Recovery Portal (MSPRP) User Guide.

10/10/2016 - 3 min read

Conditional payment disputes mired in Medicare appeals backlog

Insurers seeking appeals of adverse conditional payment decisions are finding that their cases are dragging.

9/19/2016 - 4 min read

The compliance gap: How you see your compliance vs. how Medicare sees it

There are two main categories of Medicare compliance: (1) reporting and (2) recovery. Although the law and regulations clearly state what must be done in each category and who must comply, the actual process of compliance can be quite challenging.