Breaking CMS Medicare Updates
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
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.
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
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.
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.
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.
United States District Court for Massachusetts rules that a MAP assignee has standing
New Medicare Advantage recovery case, the US District Court for MA in MSP Recovery Claims Series 44, LLC v. Bunker Hill Insurance Company, 2023 WL 4744739 two questions
Closing TPLF “data gaps” – recently discussed options and considerations
Whether parties using TPLF should be required to disclose the TPLF agreement to the opposing party as part of claims litigation continues to be a hotly debated topic.
CMS releases NGHP User Guide (Version 7.3) – updates include changes to the ORM trigger and CMS’s Unsolicited Response File process
The (CMS) has released an updated Section 111 NGHP User Guide (Version 7.3, August 7, 2023) regarding Section 111 reporting related to non-group health plans
ESG claims – TPLF’s next frontier?
This is a continuing study of emerging Third-Party Litigation Funding (TPLF) issues.
Mid-Year “Round-Up” 2023 – keeping track of Medicare and other claims updates (ICYMI)
We are at the mid-point for 2023! It has been a busy year in so many claims areas. Time to regroup on the key claims updates over the past months – ICYMI style!
CMS’s Section 111 NGHP Unsolicited Response File “opt-in” process – Nutshell Summary Resource
CMS’s Section 111 NGHP Unsolicited Response File “opt-in” process – Nutshell Summary Resource. The following “Nutshell Summary” is a general summary of this process.
Understanding CMS’s Section 111 NGHP Unsolicited Response File “opt-in” process (starts July 2023) – Q&A resource (updated)
Understanding CMS’s Section 111 NGHP Unsolicited Response File “opt-in” process (starts July 2023) – Q&A resource (updated)
Governor Edwards vetoes Louisiana’s proposed Third-Party Litigation Funding (TPLF) disclosure bill
S.B. 196, as outlined more fully below, called for the disclosure of (TPLF), referred to as “litigation financing agreements” in the bill, in civil actions.
Indiana enacts statutory provision regarding third-party litigation funding (TPLF) disclosure
On April 20, 2023, Indiana Governor Eric Holcomb (R) signed into law Indiana House Bill 1124 which adds a third-party litigation funding (TPLF)