Breaking CMS Medicare Updates

12/11/2020 - 4 min read

CMS holds NGHP beneficiary recovery process webinar

On 12/9, CMS held a non-group health plan beneficiary recovery process webinar aimed at attorneys who represent beneficiaries and other beneficiary representatives.

12/9/2020 - 5 min read

PAID Act passes House, moves to the Senate

The House of Representatives passed the PAID Act as a stand-alone bill and as part of the BENES Act of 2019. Both bills now move to the Senate for further consideration.

11/30/2020 - 6 min read

CMS retains $750 low dollar threshold for 2021

CMS has announced it is retaining its current $750 low dollar threshold for 2021.

11/13/2020 - 5 min read

CMS releases new NGHP Section 111 User Guide (Version 6.1) and Technical Alert

CMS’ recently released NGHP Section 111 User Guide and Technical alert outline the eventually elimination of the ‘SP31’ error notices and updates to the “soft error” classifications.

11/10/2020 - 1 min read

CMS NGHP Beneficiary Recovery Process webinar December 9th

CMS has released a notice announcing that it will be holding a Non-Group Health Plan (NGHP) Beneficiary Recovery Process webinar on December 9, 2020, at 1:00 p.m. ET.

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10/8/2020 - 2 min read

CMS releases updated Medicare Secondary Payer Recovery Portal user guide

On 10/5/20, CMS released an updated Medicare Secondary Payer Recovery Portal (MSPRP) User Guide. The changes update the claims listing interface to provide additional functionality.

10/6/2020 - 5 min read

CMS releases new NGHP Section 111 User Guide (Version 6.0) and updated accepted/excluded ICD code listings

On 10/5/20, CMS released an updated Section 111 NGHP User Guide, V. 6.0. They also released updated versions of accepted and excluded ICD-9 and ICD-10 codes for 2021.

10/6/2020 - 1 min read

CMS releases new WCMSA Reference Guide (Version 3.2)

On 10/5/20, CMS released its latest version of the WCMSA Reference Guide, Version 3.2. This guides replaces version 3.1, released on 5/11/20.

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.

Breaking CMS Medicare Updates

The PAID Act is now law

CMS holds NGHP beneficiary recovery process webinar

PAID Act passes House, moves to the Senate

CMS retains $750 low dollar threshold for 2021

CMS releases new NGHP Section 111 User Guide (Version 6.1) and Technical Alert

CMS NGHP Beneficiary Recovery Process webinar December 9th

CMS releases updated Medicare Secondary Payer Recovery Portal user guide

CMS releases new NGHP Section 111 User Guide (Version 6.0) and updated accepted/excluded ICD code listings

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