Medicare Secondary Payer (MSP)

10/25/2023 - 1 min read

CMS to Hold Section 111 Webinar on November 13th – CMS to Discuss Expansion of TPOC reporting to include WCMSA information

CMS’s webinar notice, this session will focus on the expansion of TPOC reporting to include workers’ compensation Medicare set-asides (WCMSA).

10/11/2023 - 24 min read

CMS’s Section 111 Penalties “Final Rule” Released – Breaking Down CMS’s Penalty Provisions and How They Impact Section 111 Reporting

In an important development, CMS has released its Section 111 penalties “Final Rule” --- CMS penalties will go live in 60 days.

10/10/2023 - 2 min read

An Award-Winning Effort Breaks New Ground in Medical Record Review

Verisk leaders earn Technology Innovation honoree status in the 2023 PC360 Insurance Luminary program for their work on Discovery Navigator

9/28/2023 - 16 min read

OIRA Issues New Notice Regarding Section 111 Civil Money Penalties - Notice Addresses the Proposed Rule’s Economic Impact Designation

As many will recall, earlier this year the (CMS) extended the timeline to release its Section 111 civil money penalties (CMP) “Final Rule” until February 18, 2024.

9/18/2023 - 4 min read

CMS announces increase to Maximum Settlement Amount for Fixed Percentage Demand Calculation Option starting October 2, 2023

CMS has announced that effective October 2, 2023, the maximum total settlement amount for the Fixed Percentage Demand Calculation Option.

9/11/2023 - 33 min read

The Minnesota Supreme Court rules that a TPLF agreement’s 60% “repurchase rate” is not subject to MN’s usury statute; remands case back to the district court to determine if this rate is “unconscionable” (and, thus unenforceable) under common-law

One of the issues regarding TPLF concerns whether the interest rates charged by litigation funders can be considered excessive, or legally unenforceable.

8/10/2023 - 20 min read

United States District Court for Massachusetts rules that a MAP assignee has standing

New Medicare Advantage recovery case, the US District Court for MA in MSP Recovery Claims Series 44, LLC v. Bunker Hill Insurance Company, 2023 WL 4744739 two questions

8/8/2023 - 9 min read

CMS releases NGHP User Guide (Version 7.3) – updates include changes to the ORM trigger and CMS’s Unsolicited Response File process

The (CMS) has released an updated Section 111 NGHP User Guide (Version 7.3, August 7, 2023) regarding Section 111 reporting related to non-group health plans

8/7/2023 - 12 min read

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

Interesting new Medicare Advantage recovery case, the United States District Court for Connecticut in MSP Recovery Claims, Series LLC v. Travelers Indemnity Company

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.

11/9/2022 - 14 min read

Back to the drawing board: CMS’s future medicals proposals are withdrawn – where does this leave LMSAs?

As reported in our October update, the Centers for Medicare and Medicaid Services’ (CMS’s) future medicals proposals have been withdrawn.

8/18/2022 - 29 min read

The U.S. Eleventh Circuit Court of Appeals applies a four-year statute of limitations to an MSP private cause of action claim – dismisses action as untimely

In an important new MSP decision, the U.S. Circuit Court of Appeals for the Eleventh Circuit in MSPA Claims 1, LLC v. Tower Hill Prime Insurance Co.

6/30/2022 - 2 min read

Claims commitment: Empowering insurers on the innovation journey

The insurance industry has experienced tremendous change in the past few years.

5/17/2021 - 2 min read

CMS updates Chapter 7 of the Medicare secondary payer (MSP) recovery manual

The Centers for Medicare and Medicaid Services (CMS) has released an update to Chapter 7 of its Medicare secondary payer (MSP) recovery manual.

3/12/2021 - 4 min read

The COMP Act is reintroduced in the U.S. Senate

On 3/10/21, Senators Ben Cardin (D-MD) and Rob Portman (R-OH) introduced the Coordination of Medicare Payments and Workers’ Compensation Act (COMP Act) (S. 653) into the United States Senate.