Category Archives: Medicare Reporting Section 111

CMS Improves Information to Better Manage Recoveries

14 Nov 2014 Roy Franco No Comments

Blog, Medicare Reporting Section 111, RRE, Uncategorized

CMS issued a new Technical Alert on November 10, 2014. Click here to read it in its entirety. No action is required by Franco Signor clients. CMS, effective July 1, 2015, will provide RREs with the ability to identify a “Recovery Agent” for conditional payments. To do so, new fields will be added to the MMSEA TIN Reference File, and …
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Blog, Medicare Conditional Payments, Medicare Reporting Section 111, Reimbursements

In Nawas v. State Farm Mut. Auto. Ins. Co., 2014 U.S. LEXIS 128365, a District Court within the 6th Circuit decided whether there existed a “condition precedent” requiring plaintiff to establish “demonstrated responsibility” of the defendant before plaintiff could proceed with a Medicare Secondary Payer private cause of action.  Under 42 U.S.C Section 1395y(b)(3)(A), a primary plan is subject to …
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Blog, Medicare Reporting Section 111, Medicare Secondary Payer News

Medicare does not assert MSP liability insurance-based recovery claims against settlements, judgments, awards, or other payments where the date of incident (DOI) occurred before December 5, 1980.   This policy is simple in application for traumatic induced injuries, but has presented challenges for claims involving exposure, ingestion or implantation type issues.  The law defines continuous exposure, ingestion or when an implant …
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Blog, Medicare Advantage Part C, Medicare Reporting Section 111

At Franco Signor we are seeing a steady increase in post-settlement requests being sent from Medicare Advantage Plans (MAPs) to claimants looking for confirmation of coverage.  The reason this is happening is simple: CMS requires defendants to report settlements with Medicare beneficiaries.  Included in the long list of data in such Reports is information about the defendant and/or Third-Party Administrator …
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Blog, Medicare Reporting Section 111

Earlier this year, Congress passed the Protecting Access to Medicare Act of 2014 (PAMA) (Pub. L. No. 113-93) which included amongst the various provisions a requirement prohibiting the Secretary of Health & Human Services from replacing ICD-9 Diagnosis codes prior to October 1, 2015.  As a consequence of that law, CMS issued a Technical Alert last week to discuss the delayed implementation …
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Blog, Medicare Reporting Section 111, TPOC

In a move that was expected, on February 28, 2014, CMS issued the attached Alert clarifying the $1,000 / $2,000 issue we identified in our recent blog.  The MIR threshold for TPOC’s in liability settlements remains at $2,000 until October 14, 2014 when it is reduced to $1,000.  Settlements below $1,000 are exempt from conditional payment development.   This means that for the …
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CMS Publishes Annual Threshold Required by SMART

20 Feb 2014 Roy Franco No Comments

Blog, Medicare Reporting Section 111

In a flurry of CMS Alerts yesterday the Centers for Medicare & Medicaid Services (CMS) published the annual Medicare Secondary Payer (MSP) exemption threshold required by the SMART legislation that became law last year.  Under SMART, the publication is due each November 15th, and is effective for the following calendar year.  CMS did not explain why it had missed the …
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Blog, Medicare Reporting Section 111

CMS released their latest User Guide to update two important recent developments. First and foremost, to harmonize the document to reference the correct Medicare recovery contractor.  The BCRC (Benefits Coordination & Recovery Center) is officially open for business, and with it comes the retirement of the Coordination of Benefits Contractor (COBC) and the Medicare Secondary Payer Recovery Contractor (MSPRC).   This …
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Blog, Medicare Reporting Section 111, Medicare Secondary Payer News

Today the following was submitted to Medicare in regards to their request for comment on MMSEA Penalties. CLICK HERE TO READ THE FULL LETTER

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