Breaking CMS Medicare Updates

6/9/2023 - 7 min read

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)

6/9/2023 - 48 min read

Several industry groups renew calls for a mandatory TPLF disclosure rule as part of the Federal Civil Rules of Procedure

6/7/2023 - 11 min read

CMS holds webinar to discuss the Section 111 Non-Group Health Plan (NGHP) Unsolicited Response File “opt-in” feature (starts July 2023) and other Section 111 items

(CMS) held a webinar where the agency discussed its upcoming Section 111 Non-Group Health Plan (NGHP) Unsolicited Response File “opt-in” feature (starts July 2023)

6/7/2023 - 20 min read

CMS releases Section 111 NGHP User Guide (Version 7.2, June 5, 2023) – new changes include: NGHP Unsolicited Response File, ORM reporting trigger, ORM termination, and HEW software

(CMS) has released an updated Section 111 NGHP User Guide regarding Section 111 reporting related to non-group health plans.

6/7/2023 - 8 min read

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.

5/23/2023 - 9 min read

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.

5/18/2023 - 4 min read

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.

5/16/2023 - 1 min read

CMS to hold a Section 111 Non-Group Health Plan (NGHP) Unsolicited Response File Webinar on Tuesday June 6, 2023

5/16/2023 - 15 min read

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”

5/16/2023 - 16 min read

Harnessing AI and ML through Discovery Navigator to save time and money on medical records review

Understand the vital role of AI in automating record reviews and how it addresses current industry challenges.

5/3/2023 - 6 min read

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).

5/1/2023 - 10 min read

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)

4/26/2023 - 18 min read

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.

4/26/2023 - 1 min read

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).

Breaking CMS Medicare Updates

Governor Edwards vetoes Louisiana’s proposed Third-Party Litigation Funding (TPLF) disclosure bill

Indiana enacts statutory provision regarding third-party litigation funding (TPLF) disclosure

Several industry groups renew calls for a mandatory TPLF disclosure rule as part of the Federal Civil Rules of Procedure

CMS holds webinar to discuss the Section 111 Non-Group Health Plan (NGHP) Unsolicited Response File “opt-in” feature (starts July 2023) and other Section 111 items

CMS releases Section 111 NGHP User Guide (Version 7.2, June 5, 2023) – new changes include: NGHP Unsolicited Response File, ORM reporting trigger, ORM termination, and HEW software

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

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

CMS releases the WCMSA Reference Guide Version 3.9

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

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)

CMS’s Query Process and non-binary/unspecified gender designations – current issues and considerations

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

Starting April 29, 2023, CMS Will Use the 2020 CDC Life Table for WCMSAs