Medicare Secondary Payer (MSP)
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.
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.
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.
Shawn Deane will lead industry initiatives as president of NAMSAP
Shawn Deane, vice president of Medicare / Medicaid compliance and policy, has been elected president of the National Alliance for Medicare Set-Aside Professionals.
Important SSNRI news at CMS forum
To comply with the Medicare Access and CHIP Reauthorization Act of 2015, CMS announced the Social Security Number Removal Initiative on Tuesday, January 17.
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.
Removing roadblocks to settlements: Medicare Part C claims in the way of your settlement
The last half-dozen years have seen Medicare Secondary Payer (MSP) compliance evolve, with the most recent example being its change in focus from mandatory insurer…
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.
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…
Conditional payment disputes mired in Medicare appeals backlog
Insurers seeking appeals of adverse conditional payment decisions are finding that their cases are dragging.
The SPARC Act may have implications for future Medicare Advantage Plan rulings
On September 22, Congressmen Tim Murphy (R-PA) and Ron Kind (D-WI) introduced legislation designed to clarify the Medicare Secondary Payer (MSP).
Should you purchase MSA liability insurance?
Medicare Set-Asides (MSAs) are primarily a coordination of benefits tool. The failure to obtain & adequately fund an MSA can result in a denial of payment.
Medicare Advantage Plans allowed to sue no-fault carriers for private cause of action
New ruling likely to lead to more MAP lien claims against PIP insurers.
Preparing for a fundamental compliance shift in liability claims
Liability claims are particularly at risk, as these emerging compliance issues impose new burdens on the management and settlement of claims.
MSP statute extends its reach in the 11th Circuit: Foreshadowing for liability MSAs?
Undoubtedly, the 11th Circuit Court decision in Humana has obvious financial consequences to insurers.