Category Archives: Medicare Reporting Section 111

Blog, Legal/Legislative News, Medicare Reporting Section 111, Medicare Secondary Payer News

As we had blogged about last October, the 9th Circuit in CIGA v. Azar held that CIGA as a Guaranty Fund was not a “primary plan” under the MSP, due to the fact that CIGA pays for medical care only if the insurer is insolvent, and as such the WC claim does not automatically trigger coverage. For our prior blog, …
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Blog, Franco Signor News, Legal/Legislative News, Medicare Reporting Section 111, Medicare Secondary Payer News

All attendees must register separately. You will receive the log-in/call-in information once you register. Click the link below to register for this webinar session to be held on Mar 26, 2020 1:30 PM EDT. https://attendee.gotowebinar.com/register/300143989975532034   Don’t miss this opportunity to hear from the experts! The Centers for Medicare & Medicaid Services (CMS) recently concluded its Proposed Rule on Civil …
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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 Reporting Section 111, Medicare Secondary Payer News

As we had blogged on just last week, today CMS officially published its Proposed Rule on “Medicare Secondary Payer and Certain Civil Monetary Penalties.” The link to the published Proposed Rule in the Federal Register can be found here. Additionally, CMS’ Fact Sheet on the Proposed Rule can be found here. The deadline to offer public comments to the rule …
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Blog, Legal/Legislative News, Medicare Reporting Section 111, Medicare Secondary Payer News

Yesterday, we learned CMS intends to publish its proposed Civil Monetary Penalty (CMP) rules for Section 111 Medicare & Medicaid SCHIP Extension Act reporting on 2/18/2020.  The Notice of Proposed Rule Making (NPRM) is the first step toward implementing a final rule that will impose penalties of up to $1,000 per day, per claim against Non-Group Health Plans (NGHPs) for …
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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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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, LMSA, Medicare Reporting Section 111, Medicare Set Aside

We have previously blogged regarding two Notice of Proposed Rulemakings (NPRMs) regarding Section 111 Civil Monetary Penalties and MSP and Future Medicals (which will propose options for LMSAs and/or protecting Medicare’s future interest in General Liability claims) pending on the Office of Management and Budget (OMB)’s website. Our prior blog on the Section 111 rulemaking can be found here and …
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Blog, Legal/Legislative News, Medicare Jurisdiction, Medicare Reporting Section 111, Medicare Secondary Payer News

The Medicare Advocacy Recovery Coalition (MARC) has announced that the Provide Accurate Information Directly (PAID) Act was introduced yesterday, February 27, 2019 in the U.S. House of Representatives as H.R. 1375 by lead Co-Sponsors Reps. Ron Kind (D-WI) and Gus Bilirakis (R-FL). Representatives Kind and Bilirakis have sponsored this bipartisan legislation to improve the Medicare Secondary Payer Act (MSP). PAID’s …
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Blog, Medicare Reporting Section 111, Medicare Secondary Payer News, RRE

The Centers for Medicare & Medicaid Services (CMS) has issued yet another abundantly clear signal that Medicare Secondary Payer (MSP) enforcement will be a priority in 2019. Just last week, we blogged that a Proposed Rule on a voluntary review process for Liability Medicare Set-Asides (LMSAs) would be issued by September 2019. Now, an additional notice on the Office of Management and …
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