Centers for Medicare & Medicaid Services (CMS)

3/5/2021 - 1 min read

Starting March 27, 2021, CMS will use the 2018 CDC Life Table for WCMSAs

Starting 3/27/21, CMS has announced that it will use the new 2018 CDC Life Table to calculate adjusted life expectancies in Workers’ Compensation Medicare Set-Asides (WCMSAs).

1/22/2021 - 6 min read

CMS releases new NGHP Section 111 User Guide (Version 6.2, January 11, 2021)

CMS has released an updated Section 111 NGHP User Guide (Version 6.2, January 11, 2021) regarding non-group health plans (liability, no-fault, and workers’ compensation).

12/11/2020 - 4 min read

CMS holds NGHP beneficiary recovery process webinar

On 12/9, CMS held a non-group health plan beneficiary recovery process webinar aimed at attorneys who represent beneficiaries and other beneficiary representatives.

12/9/2020 - 5 min read

PAID Act passes House, moves to the Senate

The House of Representatives passed the PAID Act as a stand-alone bill and as part of the BENES Act of 2019. Both bills now move to the Senate for further consideration.

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12/7/2020 - 12 min read

New case highlights how LMSA issues and questions continue to complicate liability claim settlements

In Abate V. Wal-Mart Stores East, L.P. the court found CMS’s 9/30/11 memo didn’t mandate the plaintiff get a letter from her doctor certifying treatment was completed or that settling parties create a LMSA where treatment is ongoing.

11/30/2020 - 6 min read

CMS retains $750 low dollar threshold for 2021

CMS has announced it is retaining its current $750 low dollar threshold for 2021.

11/13/2020 - 5 min read

CMS releases new NGHP Section 111 User Guide (Version 6.1) and Technical Alert

CMS’ recently released NGHP Section 111 User Guide and Technical alert outline the eventually elimination of the ‘SP31’ error notices and updates to the “soft error” classifications.

11/10/2020 - 6 min read

Medicare conditional payment round-up

CMS has been quite active this year announcing several updates to its Medicare Secondary Payer Recovery Portal and holding a recent webinar on redetermination requests

7/8/2020 - 6 min read

Seven steps to closed: Maximizing claims settlement projects

There's a thin and potentially costly line between settling a claim and keeping it open. Using a claims settlement project can help close claims faster.

5/1/2020 - 19 min read

Court finds state of Rhode Island compliant with Section 111 despite its inability to obtain social security information to determine Medicare status and enforces settlement

The U.S. District Court in Ruiz v. Rhode Island was called upon to address whether a personal injury settlement should be enforced even though the defendant was unable to obtain the plaintiff’s social security number, or the last five digits of his SSN, to determine his Medicare status through CMS’s Section 111 Query Process.

3/30/2020 - 9 min read

Settling claims in unsettling times

In a time of social distancing and uncertainty, many are left wondering how our current working and social paradigm will impact workers’ compensation claims handling – especially being able to close claims.

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8/22/2019 - 4 min read

CRC looks to resolve backload of conditional payment leads

On 8/9/19, the Commercial Repayment Center hosted a conference call to discuss the handling of conditional payment letters versus conditional payment notices.

8/1/2019 - 3 min read

WCMSA RX update – FDA approves first generics of Lyrica

On 7/22/19, the FDA announced it approved the first generics of Lyrica. This comes at a critical time as CMS has increasingly been including Lyrica in WCMSAs

7/26/2019 - 9 min read

Massachusetts court: Medicare Advantage Plan’s assignee can sue for “double damages” under the MSP

Massachusetts is the latest jurisdiction to take a favorable view of MAPs possessing private cause of action rights under the Medicare Secondary Payer.

6/27/2019 - 4 min read

Think about your thresholds: Preventing errors to avoid CMS penalties

One way responsible reporting entities can attempt to achieve full CMS compliance and avoid potential penalties is to closely consider file thresholds.