Breaking CMS Medicare Updates

12/5/2023 - 1 min read

CMS to Hold NGHP Section 111 Penalties Webinar

CMS will be holding a Section 111 civil money penalties (CMP) webinar for (NGHPs) on January 18, 2024 at 1:00 p.m. ET.

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

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.

9/18/2023 - 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.

9/11/2023 - 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.

8/10/2023 - 20 min read

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

8/9/2023 - 19 min read

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.

8/8/2023 - 9 min read

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

7/19/2023 - 7 min read

ESG claims – TPLF’s next frontier?

This is a continuing study of emerging Third-Party Litigation Funding (TPLF) issues.

6/28/2023 - 10 min read

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!

6/27/2023 - 5 min read

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.

6/27/2023 - 22 min read

Understanding CMS’s Section 111 NGHP Unsolicited Response File “opt-in” process (starts July 2023) – Q&A resource (updated)

Breaking CMS Medicare Updates

CMS Announces Updates to the Medicare Secondary Payer Recovery Portal

CMS to Hold NGHP Section 111 Penalties Webinar

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

CMS’s Section 111 Penalties “Final Rule” Released – Breaking Down CMS’s Penalty Provisions and How They Impact Section 111 Reporting

An Award-Winning Effort Breaks New Ground in Medical Record Review

OIRA Issues New Notice Regarding Section 111 Civil Money Penalties - Notice Addresses the Proposed Rule’s Economic Impact Designation

CMS announces increase to Maximum Settlement Amount for Fixed Percentage Demand Calculation Option starting October 2, 2023

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

United States District Court for Massachusetts rules that a MAP assignee has standing

Closing TPLF “data gaps” – recently discussed options and considerations

CMS releases NGHP User Guide (Version 7.3) – updates include changes to the ORM trigger and CMS’s Unsolicited Response File process

ESG claims – TPLF’s next frontier?

Mid-Year “Round-Up” 2023 – keeping track of Medicare and other claims updates (ICYMI)

CMS’s Section 111 NGHP Unsolicited Response File “opt-in” process – Nutshell Summary Resource

Understanding CMS’s Section 111 NGHP Unsolicited Response File “opt-in” process (starts July 2023) – Q&A resource (updated)