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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Keeping Up with Conditional Payment Obligations

08 Jan 2020 Heather Sanderson No Comments

Blog, Medicare Conditional Payments

This article was originally published in the January 2020 issue of CLM Magazine. Keeping Up with Conditional Payment Obligations – Effective Strategies for Medicare Conditional Payment Recovery Cost Containment  Read the article from CLM Magazine or download the PDF.  

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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Fix Medicare’s Broken Secondary Payer System

13 Dec 2019 Roy Franco No Comments

Blog, Franco Signor News, Legal/Legislative News

Read Roy Franco’s Op-Ed Published by Inside Sources on December 12, 2019 The deadline has come and gone, and Congress is still working on funding the government for the fiscal year. In late November, lawmakers passed a continuing resolution to give themselves another month to pass required appropriations bills, but important questions remain on how to fund key tax and …
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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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