Breaking CMS Medicare Updates

4/25/2023 - 17 min read

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.

3/31/2023 - 12 min read

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).

3/21/2023 - 25 min read

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.

3/17/2023 - 1 min read

Medicare’s Commercial Repayment Center (CRC) updates mailing address for Non-Group Health Plan (NGHP) Medicare Secondary Payer (MSP) correspondence

3/8/2023 - 8 min read

New York expands Medical and Indemnity Data call reporting – expansion applies to all member carrier groups regardless of premium market share

2/22/2023 - 19 min read

CMS pushes back the timeline to release its Section 111 penalties “final rule” for one-year (until February 18, 2024)

In a major Section 111 development, (CMS) has extended the timeline to release its Section 111 civil money penalties (CMP) “final rule” until February 18, 2024.

2/13/2023 - 28 min read

TPLF disclosure proposals are introduced in Kansas, Mississippi, and Montana state legislatures

Third-party litigation funding (TPLF) issues will continue to present challenges on several fronts in the new year.

2/7/2023 - 8 min read

CMS makes updates to Section 111 NGHP User Guide (Version 7.0) – updates relate to upcoming changes to the NGHP Unsolicited Response File

As reported in our recent article, in early January CMS released a new version of their Section 111 NGHP Section 111 User Guide (Version 7.0, January 9, 2023).

1/17/2023 - 6 min read

CMS releases updated Medicare Secondary Payer Recovery Portal (MSPRP) User Guide (Version 5.6) – Updates to Open Debt Report, Compromise Requests, and Go Paperless notifications

The Centers for Medicare and Medicaid Services (CMS) has released an updated Medicare Secondary Payer Recovery Portal (MSPRP) User Guide Version 5.6 (January 9, 2023).

1/12/2023 - 13 min read

CMS releases Section 111 NGHP User Guide (Version 7.0, January 9, 2023) – CMS announces several new updates to kick off 2023

The (CMS) has released an updated Section 111 NGHP User Guide (Version 7.0, January 9, 2023) regarding Section 111 reporting related to non-group health plans.

1/9/2023 - 7 min read

CMS releases request for proposal for the Workers’ Compensation Review Contractor (WCRC) contract

On January 4, 2023, the Centers for Medicare and Medicaid Services (CMS) issued an RFP for its Workers’ Compensation Review Contractor (WCRC) contract.

12/22/2022 - 14 min read

Is the other “M” on your radar? 5 things to know about Medicaid and how we can help!

It is no secret that Medicare secondary payer compliance issues often dominate the claims landscape and discussion.

12/15/2022 - 4 min read

CMS retains its $750 “Low Dollar” threshold for 2023

The Centers for Medicare and Medicaid Services (CMS) has released its 2023 low dollar reporting and recovery threshold.

12/9/2022 - 17 min read

The PAID Act one year after implementation – How is it going? What are we seeing?

On 12/11/21, the (PAID Act) went live following a year-long implementation roll-out by the Centers for Medicare and Medicaid Services (CMS).

Breaking CMS Medicare Updates

CMS releases Section 111 NGHP User Guide (Version 7.1, April 24, 2023)

Second Circuit dismisses Medicare Advantage “double damages” lawsuit on standing grounds – rules the insurer’s Section 111 reporting did not establish liability

Changing of the Guard: Detail Claim Information (DCI) is sunsetting and the Indemnity Data Call (IDC) will take over – what you should know

Waiting for CMS’s Section 111 penalties “final rule” – status, updates, and what’s next

Medicare’s Commercial Repayment Center (CRC) updates mailing address for Non-Group Health Plan (NGHP) Medicare Secondary Payer (MSP) correspondence

New York expands Medical and Indemnity Data call reporting – expansion applies to all member carrier groups regardless of premium market share

CMS pushes back the timeline to release its Section 111 penalties “final rule” for one-year (until February 18, 2024)

TPLF disclosure proposals are introduced in Kansas, Mississippi, and Montana state legislatures

CMS makes updates to Section 111 NGHP User Guide (Version 7.0) – updates relate to upcoming changes to the NGHP Unsolicited Response File

CMS releases updated Medicare Secondary Payer Recovery Portal (MSPRP) User Guide (Version 5.6) – Updates to Open Debt Report, Compromise Requests, and Go Paperless notifications

CMS releases Section 111 NGHP User Guide (Version 7.0, January 9, 2023) – CMS announces several new updates to kick off 2023

CMS releases request for proposal for the Workers’ Compensation Review Contractor (WCRC) contract

Is the other “M” on your radar? 5 things to know about Medicaid and how we can help!

CMS retains its $750 “Low Dollar” threshold for 2023

The PAID Act one year after implementation – How is it going? What are we seeing?