Category Archives: Medicare Conditional Payments

Blog, Legal/Legislative News, Medicare Conditional Payments, Trial Practice

A lawsuit filed in in the United States District Court for the Southern District of Texas by the U.S. alleges that the plaintiff attorney in a personal injury action (Carrigan & Anderson, PLLC and Attorney Stephen P. Carrigan individually) failed to reimburse Medicare’s demand for conditional payments in full.  A copy of the Complaint and Exhibits can be found here: …
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Blog, Franco Signor News, Legal/Legislative News, Medicare Conditional Payments, Medicare Jurisdiction, Medicare Reporting Section 111, Medicare Secondary Payer News, Medicare Set Aside

The Different Paths to Protect the Medicare Trust Fund Medicare for All, Continued Privatization of Medicare and Growth of MSP Enforcement Are All on the Table Efficiency and expansion of healthcare coverage is of paramount concern in the 2020 presidential election. The Medicare program has particularly been in the spotlight, as Medicare accounts for a significant portion of federal spending. …
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Blog, Legal/Legislative News, Medicare Advantage Part C

In a decision out of the Eleventh Circuit, MSPA Claims v. Kingsway Amigo, 2020 U.S. App. LEXIS 4554 (February 13, 2020), Plaintiff MSPA Claims (aka MSP Recovery LLC) was able to persuade the Court that the Medicare Secondary Payer (MSP) 3-year claims filing provision located at 42 USC § 1395y(b)(2)(B)(vi) does not preclude a Medicare Advantage Organization (MAO) from filing …
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CMS Updates NGHP Guide with 2020 MSP Recovery Thresholds

10 Feb 2020 Heather Sanderson No Comments

Blog, Medicare Conditional Payments, Medicare Secondary Payer News, Reimbursements

As of January 31, 2020, CMS updated its NGHP User Guide to version 5.8 to include the 2020 MSP Recovery Thresholds. The updated NGHP User Guide Version 5.8 can be found here. As we had blogged on in December, CMS issued an Alert that the MSP recovery threshold (where reporting and conditional payment reimbursement is not required) would be maintained …
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Blog, Medicare Conditional Payments, Medicare Reporting Section 111, Medicare Secondary Payer News, Medicare Set Aside

On Tuesday, January 14th, the Centers for Medicare & Medicaid Services (CMS) hosted a Town Hall to discuss common Commercial Repayment Center (CRC) Non-Group Health Plan (NGHP) Ongoing Responsibility for Medical (ORM) recovery topics. On the main portion of the call, the following was discussed by John Albert and Nicole Griffin on behalf of CMS (note that CMS stated that …
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Keeping Up with Conditional Payment Obligations

08 Jan 2020 Heather Sanderson No Comments

Blog, Medicare Conditional Payments

This article was originally published in the January 2020 issue of CLM Magazine. Keeping Up with Conditional Payment Obligations – Effective Strategies for Medicare Conditional Payment Recovery Cost Containment  Read the article from CLM Magazine or download the PDF.  

Top Medicare Secondary Payer Predictions for 2020

03 Jan 2020 Heather Sanderson No Comments

Blog, Legal/Legislative News, Medicare Advantage Part C, Medicare Conditional Payments, Medicare Secondary Payer News, Medicare Set Aside

Medicare Secondary Payer (MSP) developments will take center-stage in 2020 and drastically impact workers’ compensation, no-fault, and general liability insurance plans/carriers. With 2020 being an election year and healthcare matters as a primary issue for Americans, the continuing debate for Medicare for All, Medicare’s rising costs with an estimate of a spend of $651 billion dollars in 2019[1], two Notices …
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Blog, Medicare Conditional Payments, TPOC

As required by Section 202 of the SMART Act, CMS is required to annually review its costs relating to recovering conditional payments as compared to recovery amounts. Since 2017, CMS has maintained its threshold of $750.00 across all Non-Group Health Plan (NGHP) lines of business to include workers’ compensation, general liability, and no-fault insurance.  The threshold means that in scenarios …
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Blog, Legal/Legislative News, Medicare Advantage Part C, Medicare Secondary Payer News, Pharma Part D

Insurance Companies and Self-Insureds that process claims for workers’ compensation, liability and no-fault claims (Primary Plans) involving Medicare beneficiary claimants need a better way to obtain information about Medicare Advantage and Part D Drug Plans that may have a claim for conditional payment reimbursement.  Numerous lawsuits have been filed across the Country demanding double damages for failure to reimburse Medicare …
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Blog, Medicare Advantage Part C

Recall last year in 2018 we blogged that Humana Medicare Advantage had filed an action against Bi-Lo, LLC, a grocery retailer, in the U.S. District Court for the District of South Carolina for declaratory relief and monetary damages to recover amounts allegedly due and owing to Humana Medicare Advantage Organization (MAO) for payments made on behalf of Enrollee (the Medicare …
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