Breaking CMS Medicare Updates
The United States District Court for Massachusetts dismisses a Medicare Advantage claim for “double damages” – rules that insurer’s Section 111 reporting does not establish standing to sue
The U.S. District Court for Massachusetts dismisses Medicare Advantage claim for “double damages”—rules insurer’s Section 111 reporting doesn't establish standing to sue.
CMS releases the WCMSA Reference Guide Version 3.9
CMS has made various updates to different aspects of its WCMSA process, including removing the time limit on Amended Reviews.
CMS to hold a Section 111 Non-Group Health Plan (NGHP) Unsolicited Response File Webinar on Tuesday June 6, 2023
CMS to hold a Section 111 Non-Group Health Plan (NGHP) Unsolicited Response File Webinar on Tuesday June 6, 2023
CMS’s NGHP Unsolicited Response File “opt-in” process starts in July 2023 – Q&A, issues, and considerations
Earlier this year (CMS) formally announced a new non-group health plan (NGHP) Unsolicited Response File “opt-in” feature. Per CMS, this new process starts “July 2023”
Harnessing AI and ML through Discovery Navigator to save time and money on medical records review
Harnessing AI and ML through Discovery Navigator to save time and money on medical records review
CMS releases Non-Group Health Plan (NGHP) Applicable Plan Appeals Reference Guide (Version 1.0)
The Centers for Medicare and Medicaid Services (CMS) has released a Non-Group Health Plan (NGHP) Applicable Appeals Reference Guide (Version 1.0, April 27, 2023).
CMS’s Query Process and non-binary/unspecified gender designations – current issues and considerations
Section 111 non-group health plan (RREs) involves the inability to submit non-binary or unspecified gender designations as part of the (CMS’s)
The Eleventh Circuit dismisses a Medicare Advantage “double damages” lawsuit – court rules the MSP statute does not preempt insurer's claims-filing deadline or Florida’s no-fault pre-suit demand
In a recent Medicare Advantage recovery action, the United States Eleventh Circuit Court of Appeals in MSP Recovery Claims.
Starting April 29, 2023, CMS Will Use the 2020 CDC Life Table for WCMSAs
The (CMS) has announced that beginning April 29, 2023, it will use the new 2020 CDC Life Table to calculate adjusted life expectancies in (WCMSAs).
CMS releases Section 111 NGHP User Guide (Version 7.1, April 24, 2023)
The Centers for Medicare and Medicaid Services (CMS) has released an updated Section 111 NGHP User Guide (Version 7.1, April 24, 2023)
Second Circuit dismisses Medicare Advantage “double damages” lawsuit on standing grounds – rules the insurer’s Section 111 reporting did not establish liability
In an interesting new Medicare Advantage recovery decision, the United States Second Circuit Court of Appeals in MSP Recovery Claims.
Changing of the Guard: Detail Claim Information (DCI) is sunsetting and the Indemnity Data Call (IDC) will take over – what you should know
The DCI is now scheduled to sunset at the end of December 2023 and is being replaced by the Indemnity Data Call (IDC).
Waiting for CMS’s Section 111 penalties “final rule” – status, updates, and what’s next
Presently, the industry is waiting for CMS to release its Section 111 CMPs “final rule” to the public.
Medicare’s Commercial Repayment Center (CRC) updates mailing address for Non-Group Health Plan (NGHP) Medicare Secondary Payer (MSP) correspondence
Medicare’s Commercial Repayment Center (CRC) updates mailing address for Non-Group Health Plan (NGHP) Medicare Secondary Payer (MSP) correspondence
New York expands Medical and Indemnity Data call reporting – expansion applies to all member carrier groups regardless of premium market share
New York expands Medical and Indemnity Data call reporting – expansion applies to all member carrier groups regardless of premium market share