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Breaking CMS Medicare Updates

The Ramp Act
June 7, 2023

The RAMP Act is re-introduced in Congress – bill proposes revisions to the MSP’s private cause of action (“double damages”) provision

On 5/16/23, (RAMP) Act was re-introduced into the U.S. House of Representatives, bill proposes revisions to the MSP’s private cause of action provision.

Gavel on a white background with a small shadow.
May 23, 2023

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.

Wcsma Version Release
May 18, 2023

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 Nghp Webinar Teaser
May 16, 2023

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

Cmss Nghp Unsolicited Response Teaser
May 16, 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 Teaser
May 16, 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 Teaser
May 3, 2023

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 Gender
May 1, 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)

11th Circuit Teaser
April 26, 2023

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.

11th Circuit Teaser
April 26, 2023

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
April 25, 2023

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 Teaser
April 25, 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.

Dci Teaser
March 31, 2023

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 Teaser
March 21, 2023

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 Commercial Teaser
March 17, 2023

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

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