Breaking CMS Medicare Updates

9/28/2020 - 5 min read

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 plans.

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8/25/2020 - 12 min read

U.S. Department of Justice and plaintiff law firm reached a settlement to resolve a Medicare conditional payment claim

The DOJ’s Attorney’s Office for the Middle District of Pennsylvania has settled a Medicare conditional payment claim with the plaintiff law firm.

8/20/2020 - 8 min read

What’s up in D.C.? Medicare Secondary Payer reform efforts – status update

With the current Congressional session ending on 1/3/21, attention is on two pending Medicare Secondary Payer reform efforts: The PAID Act & the COMP Act.

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8/14/2020 - 3 min read

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.

8/11/2020 - 4 min read

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 comment period that closed on 4/20/20.

8/7/2020 - 17 min read

Connecticut court rules Medicare Advantage Plan entitled to double damages

The U.S. District Court for Connecticut in Aetna v. Guerrera, 2020 ruled, in part, the alleged self-insured supermarket was a primary plan and liable for “double damages” for its failure to reimburse Aetna’s Medicare Advantage Plan recovery claim.

7/14/2020 - 4 min read

CMS releases updated Medicare Secondary Payer Recovery Portal (MSPRP) user guide (Version 4.9)

CMS has released an updated Medicare Secondary Payer Recovery Portal User Guide (Version 4.9, July 13, 2020). CMS has made multiple updates to the MSPRP, which the agency lists in Chapter I at page 1-1.

7/2/2020 - 21 min read

Eleventh Circuit rules that Florida Medicaid may seek recovery of its past payments from those portions of the settlement agreement representing past and future medical care

In a new Florida Medicaid decision, the U.S. Circuit Court of Appeals for the Eleventh Circuit, in Gallardo v. Dudek, 2020 ruled Florida Medicaid may seek recovery of payments made for a beneficiary’s treatment from the amounts of a settlement agreement representing both past and future medical care.

7/1/2020 - 2 min read

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).

7/1/2020 - 1 min read

CMS’s expected release of its “future medicals” proposals now scheduled for August 2020

An updated notice from the Office of Information and Regulatory Affairs indicates CMS’s long-anticipated release of its “future medicals” notice of proposed rulemaking is now scheduled for August 2020.

6/16/2020 - 9 min read

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 also now be purchased.

6/12/2020 - 2 min read

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.

6/3/2020 - 2 min read

CMS to enhance its MSPRP to allow authorized users to view and print conditional payment correspondence

Starting July 13, 2020, authorized MSPRP users will be allowed to view and print CMS conditional payment correspondence.

5/15/2020 - 1 min read

CMS releases new WCMSA reference guide (Version 3.1)

The Centers for Medicare and Medicaid Services (CMS) has just released its latest version of the WCMSA reference guide version 3.1 (May 11, 2020).

Breaking CMS Medicare Updates

CMS releases new WCMSA Reference Guide (Version 3.2)

CMS discusses conditional payment issues on NGPH applicable plans webinar

U.S. Department of Justice and plaintiff law firm reached a settlement to resolve a Medicare conditional payment claim

What’s up in D.C.? Medicare Secondary Payer reform efforts – status update

CMS holds Section 111 NGHP update webinar

OIRA releases updated information Section 111 CMPs

Connecticut court rules Medicare Advantage Plan entitled to double damages

CMS releases updated Medicare Secondary Payer Recovery Portal (MSPRP) user guide (Version 4.9)

Eleventh Circuit rules that Florida Medicaid may seek recovery of its past payments from those portions of the settlement agreement representing past and future medical care

CMS releases new NGHP Section 111 User Guide (Version 5.9)

CMS’s expected release of its “future medicals” proposals now scheduled for August 2020

Key changes to Michigan PIP start July 1, 2020 – Medicare Secondary Payer compliance impact

CMS releases Section 111 alert regarding the reporting of no-fault insurance and med-pay policy limits on claim input files

CMS to enhance its MSPRP to allow authorized users to view and print conditional payment correspondence

CMS releases new WCMSA reference guide (Version 3.1)