Section 111 Reporting
CMS discusses conditional payment issues on NGPH applicable plans webinar
On 9/24, CMS and the CRC held a webinar on redetermination requests as part of the administrative appeals process for conditional payment disputes of non-group health…
CMS holds Section 111 NGHP update webinar
On 8/13, CMS held a webinar on Section 111 non-group health plan reporting. The webinar covered NGHP Section 111 reporting best practices and MSPRP enhancements.
OIRA releases updated information Section 111 CMPs
OIRA released an updated notice on the status of CMS’s Section 111 civil money penalties proposals. CMS released the proposals in February 2020 and opened a public…
CMS releases new NGHP Section 111 User Guide (Version 5.9)
CMS has released an updated Section 111 NGHP User Guide (Version 5.9, June 29, 2020) regarding non-group health plans (liability, no-fault and workers’ compensation).
Key changes to Michigan PIP start July 1, 2020 – Medicare Secondary Payer compliance impact
While individuals will still be able to elect unlimited PIP coverage, for applicable policies issued or renewed after 7/1/20, PIP plans with different coverage limits may…
CMS releases Section 111 alert regarding the reporting of no-fault insurance and med-pay policy limits on claim input files
Limits on NGHP claim input files in situations where separate Med-Pay and PIP coverages being paid out under a single policy for the same injured party and incident.
Court finds state of Rhode Island compliant with Section 111 despite its inability to obtain social security information to determine Medicare status and enforces settlement
The U.S. District Court in Ruiz v. Rhode Island was called upon to address whether a personal injury settlement should be enforced even though the defendant was unable to…
CMS’s Section 111 civil money penalties comment period closes
With the comment period closed, the focus now turns to when CMS will issue its Final Rule, which will comprise of the agency’s official CMP regulations.
Medicare enables COVID-19 ICD-10 code for Section 111 reporting
The CDC issued a bulletin advising it is implementing the new ICD-10 U07.1 for “COVID-19, virus identified” in an off-cycle update effective 4/1/20, to code the COVID-19…
Settling claims in unsettling times
In a time of social distancing and uncertainty, many are left wondering how our current working and social paradigm will impact workers’ compensation claims handling –…
CMS’s Section 111 penalty proposals are here
CMS has released its long-awaited Section 111 civil money penalty proposals for non-group health plans, as well as group health plans.
Release of CMS’s Section 111 penalty proposals delayed again – pushed back to December
OIRA announced CMS’s expected release of its Notice of Proposed Rulemaking proposals for Section 111 civil money penalties has been pushed to December 2019.
CMS’s new Section 111 alert addresses MBI reporting
CMS has issued an updated Section 111 Alert pertaining to non-group health claims (NGHP) regarding the Medicare Beneficiary Identifier (MBI) reporting.
CMS releases new NGHP Section 111 user guide (Version 5.7)
On 10/7/19, CMS released an updated Section 111 User Guide (Version 5.7) regarding non-group health plans (liability, no-fault and workers’ compensation).
Ninth Circuit: CIGA is not a “primary payer” under the MSP and does not have to reimburse Medicare
In a significant new case out of California, the United States Circuit Court of Appeals (Ninth Circuit)[1] in California Insurance Guarantee Association (CIGA) v. Azar,…