Category Archives: Medicare Secondary Payer News

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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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, 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 Secondary Payer News, Medicare Set Aside, WCMSA

CMS has released an updated WCMSA Reference Guide version 3.0. It can be found here.  The two significant changes are 1) CMS extending the Amended Review period from 4 to 6 years (Section 16.2), and 2) As of April 1, 2020, the required language for the signed consent form to submit an MSA to CMS now must include a statement …
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CMS Updates NGHP User Guide with Minor Changes

08 Jul 2019 Heather Sanderson No Comments

Blog, Legal/Legislative News, Medicare Secondary Payer News

As of July 1, 2019, CMS updated its NGHP User Guide to Version 5.6 with Minor Changes. A list of the changes made in the new Guide can be found here. Additionally, the updated Guide can be found at https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Mandatory-Insurer-Reporting-For-Non-Group-Health-Plans/NGHP-User-Guide/NGHP-User-Guide.html. Contact us with any questions at engage@francosignor.com.

Blog, Legal/Legislative News, Medicare Conditional Payments, Medicare Secondary Payer News, Pharma Part D

Several of our clients have been experiencing an increase in conditional payment letters from Medicare Part D prescription drug plans. Historically, Part D plans have been less active in recovery of conditional payments than traditional Medicare or Medicare Advantage Part C plans; however, the tide appears to be changing. Why are Part D Plans recently increasing their recovery efforts? One …
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Blog, Franco Signor News, Medicare Secondary Payer News

2019 has been a particularly active year with regard to enforcement of the Medicare Secondary Payer Act (MSP). The rulemakings on Liability Medicare Set-Asides (LMSAs) and Section 111 penalties are on schedule to be issued in September of this year. Further, the industry has experienced an increase in Medicare Advantage and Part D recoveries, as well as an increase in …
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About Franco Signor, Blog, Franco Signor News, Legal/Legislative News, Medicare Secondary Payer News

Originally published in CLM Magazine April 2019 Edition Following the Rules: Proposed Rules Aim to Clarify Enforcement of Medicare Secondary Payer Compliance In December 2018, two (2) notices were posted on the Office of Management and Budget (OMB) website signaling that the Department of Health & Human Services (DHHS)/Centers for Medicare & Medicaid Services (CMS) plans to move forward with …
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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, Legal/Legislative News, Medicaid Third Party Liability Recoveries, Medicare Secondary Payer News

The following article was co-written by: Roy Franco, Chief Client Officer and Matthew Newman, Associate Compliance Counsel A U.S. District Court’s ruling regarding MSP Recovery LLC’s recent filings in State Court has raised concerns about a possible Medicaid Third Party Liability recovery strategy.  The situation involves an archaic discovery mechanism (“bill of pure discovery”) that would allow MSP Recovery LLC …
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