Claims

11/16/2023 - 10 min read

CMS Discusses Plans to Capture WCMSA Data Points as Part of TPOC Reporting During Recent Section 111 Webinar

CMS held a webinar to discuss its plans to require Section 111 (RREs) to report data points related to WCMSAs

11/7/2023 - 15 min read

CMS Releases New Section 111 Penalties FAQ Resource

CMS has now released a new Alert entitled CMS’s Medicare Secondary Payer and Certain Civil Money Penalties: Frequently Asked Questions

11/7/2023 - 6 min read

Love Thy Frenemies: 3 Reasons an Interconnected Claims Network Benefits the Industry

10/31/2023 - 4 min read

Who Commits Insurance Fraud, Part 3: "Which Generation is Most Likely to Commit Fraud?

Verisk conducted a study with the Coalition Against Insurance Fraud on which generation is most likely to commit fraud.

10/31/2023 - 4 min read

Introducing Recovery Reversal: Your Key to Regaining Control Over Medicare Conditional Payments

Verisk developed a new solution - Recovery Reversal - to claw back the Medicare overpayment or offset.

10/30/2023 - 3 min read

Vermont Department of Labor Delays Mandatory Start Date of Release

Vermont EDI Claim Release 3.1 for (FROI) and (SROI) is now delaying its planned implementation of Release 3.1 for FROI/SROI reporting.

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.

9/28/2023 - 19 min read

The “Protecting Our Courts from Foreign Manipulation Act of 2023” is Introduced in Congress – Proposal Targets TPLF by Foreign Persons, Foreign States, and Foreign Sovereign Wealth Funds

In an important development on the TPLF front, the Protecting Our Courts from Foreign Manipulation Act of 2023 has been introduced in the U.S Senate.

9/27/2023 - 3 min read

Who commits insurance fraud What motivates insurance fraud?

Part two of Verisk's study delved deep into public perceptions and attitudes toward what motivates them to commit insurance fraud.

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.

9/13/2023 - 3 min read

Reminder update: Vermont transitions to Release 3.1 regarding First Report of Injury (FROI) and Subsequent Report of Injury (SROI) effective November 6, 2023

This is an important reminder that the (VDOL) will transition from (EDI) Claims R1.0 (FROI and SROI) to EDI Claims R3.1 (FROI and SROI) effective November 6, 2023.

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.