Medicare Secondary Payer (MSP)

1/12/2018 - 3 min read

Medicare Advantage Plans update: Illinois court indicates MAPs have “double damages” rights

Whether Medicare Advantage Plans have private cause of action rights to sue claims payers (and others) for “double damages” under the Medicare Secondary Payer (MSP) statute remains a major concern for the claims industry.

12/21/2017 - 3 min read

CMS Releases New Section 111 NGHP User Guide (Version 5.3)

The Centers for Medicare and Medicaid Services (CMS) has released an updated Section 111 non-group health plan (NGHP) User Guide (Version 5.3, December 15, 2017).

11/27/2017 - 6 min read

Medicare Part D - The next recovery frontier?

Spurred by a number of favorable court decisions allowing MAPs to sue for “double damages” under the MSP statute, Medicare Part D plans are now beginning to step into the recovery arena.

10/26/2017 - 1 min read

Liability MSA update

On October 26, 2017, the Centers for Medicare and Medicaid Services (CMS) has released its latest update regarding the LMSA issue.

10/6/2017 - 2 min read

Performant awarded CMS Commercial Repayment Center contract

The Centers for Medicare and Medicaid Services (CMS) awarded Performant Financial Corporation (Performant) the Commercial Repayment Center (CRC) contract.

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.

6/16/2017 - 6 min read

Court blocks Medicare discovery requests - Ruling limits insurer's ability to determine MMSEA obligations

A new case out of Connecticut highlights complications insurers can encounter in obtaining information to assess their MSP compliance obligations.

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.

2/17/2017 - 1 min read

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.

1/18/2017 - 5 min read

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.

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.

11/11/2016 - 4 min read

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 reporting to rolling recovery.

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.