Category Archives: Medicare Secondary Payer News

Blog, Legal/Legislative News, Medicare Secondary Payer News, Trial Practice

The False Claims Act’s (FCA) purpose is to deter fraud upon the U.S. government, and whistle-blowers are incentivized to bring such actions due to the potential to recover triple damages against the fraudulent entity. With regard to Medicare Secondary Payer (MSP) FCA litigation, we have really only seen two whistleblowers try to bring MSP FCA actions up until now, United …
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Blog, Medicare Reporting Section 111, Medicare Secondary Payer News

As part of Section 202 of the SMART Act, CMS is required to annually compute a threshold amount in which liability insurance (including self-insurance) settlements are exempt from MMSEA Section 111 reporting requirements, as well as from the requirement to reimburse conditional payments to Medicare. In 2013, CMS announced that the threshold would be $1000 effective January 1, 2014. CMS …
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CMS Releases FAQ Document on CRC

26 Oct 2015 Heather Sanderson No Comments

Blog, Medicare Conditional Payments, Medicare Secondary Payer News

Today, October 26, 2015, CMS released a Frequently Asked Question (FAQ) document on the new Commercial Repayment Center (CRC) (click here). The FAQ provides the same/similar guidance previously provided on CMS webinar held on September 17th. However, of particular mention in the FAQ not previously brought to light is that the CRC will generally not issue correspondence/CPNs when the conditional payment …
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Blog, Franco Signor News, Medicare Jurisdiction, Medicare Secondary Payer News

We are told that we must protect Medicare’s interest. But what about our own? We are told in workers’ compensation settlements that involve a Medicare beneficiary, or a person who is “reasonably expected to become a Medicare beneficiary within 30 months of the settlement,” that we must protect Medicare’s interest. What does that mean and, more importantly, what is the …
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ICD-10: One Week Out

25 Sep 2015 Jesse Hamby No Comments

Blog, Medicare Jurisdiction, Medicare Secondary Payer News

In one week, the U.S. health care system will start using the International Classification of Diseases, 10th Revision. This is a huge moment because ICD-10 will help doctors and other health care providers better: Define patients’ clinical status and treat their complex medical conditions. Coordinate care among providers. Support new payment methods that drive quality of care. Continue Reading

Blog, Medicare Jurisdiction, Medicare Secondary Payer News

We previously issued a blog which discussed the new implementation of a MFA process for the MSPRP. For our prior blog, please click here. Last week, CMS issued a document which provides additional guidance and background information surrounding the RIDP and MFA services. The document can be found here, but a summary of the document follows below. RIDP is the process of …
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Blog, Medicare Reporting Section 111, Medicare Secondary Payer News, Medicare Set Aside

The Casualty Actuarial Society (CAS) Committee on Health Care Issues recently analyzed ten cases to estimate the future impact of Medicare Secondary Payer reporting requirements to the P&C industry.  The CAS study was published in an article in Claims Journal.  The cases studied involved insurance in various lines of business: workers’ compensation, private passenger automobile and homeowners insurance.  The study …
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More MSP Private Cause of Action “Action”

02 Sep 2015 Heather Sanderson No Comments

Blog, Medicare Advantage Part C, Medicare Jurisdiction, Medicare Secondary Payer News, Medicare Set Aside

A new opinion was just released out of the U.S. District Court for the Southern District of Florida, MSPA Claims 1, LLC v. IDS Property Casualty Insurance Company (August 28, 2015). This case involved MSPA Claims 1, LLC (“MSPA Claims”), as an assignee and on behalf of Florida Healthcare Plus (FHCP), a Medicare Advantage Plan (MAP), pursuing Property Casualty Insurance …
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Blog, Medicare Jurisdiction, Medicare Reporting Section 111, Medicare Secondary Payer News

As part of the Strengthening Medicare and Repaying Taxpayers (SMART) Act, the Centers for Medicare & Medicaid Services (CMS) has implemented optional MFA services which are now available on the MSPRP. MFA is the use of two or more different authentication factors to verify the identity of a user. Verified users will now have access to view unmasked claims data …
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Blog, Medicare Conditional Payments, Medicare Secondary Payer News

Today, July 1, 2015, CMS issued an alert which states that come October 2015, the Benefits Coordination and Recovery Contractor will be transitioning some of its recovery caseload to a new contractor which will be known as the Commercial Repayment Center (CRC). The CRC will be handling conditional payment recovery where CMS is pursuing recovery directly from a liability insurer …
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