Category Archives: Medicare Secondary Payer News

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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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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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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