Medicare Secondary Payer False Claims Act Update

Lately, we have seen an increase in Medicare Secondary Payer (MSP) False Claims Act (FCA) litigation in Federal courts. Below is an update on two prior existing MSP FCA cases- U.S. ex rel. Kent Takemoto (U.S. Court of Appeals, 2nd Circuit), and Negron v. Progressive (U.S. District Court, New Jersey). Additionally, we have become aware of the now unsealed MSP … Read more »

Social Security Number Removal Initiative (SSNRI) Impact to Section 111 Reporting

Heather Sanderson Blog, Medicare Reporting Section 111 No Comments

Yesterday, CMS hosted a Town Hall regarding the SSN removal initiative (SSNRI) and its impact to Medicare Secondary Payer processes and particularly MMSEA Section 111 Reporting; For our prior blog on this Town Hall and the SSNRI, click here. There were two parts to the call: In the first segment, CMS explained its overall plan for SSNRI generally and how … Read more »

U.S. California District Court Rules Medicare Reimbursement is Limited to Related Injuries Identified by Diagnosis Codes

Franco Signor always take the position on behalf of our Clients to aggressively dispute unrelated charges related to Medicare’s claim for conditional payment reimbursement.  Our efforts have resulted in well over 90% reductions in charges because of it.  This case, brought by the California Insurance Guarantee Association (CIGA) explains why it is important to remain proactive in managing your conditional … Read more »

NGHP User Guide Version 5.2 Released

Heather Sanderson Blog, Medicare Reporting Section 111, ORM, TPOC No Comments

CMS has released an updated Non-Group Health Plan (NGHP) User Guide version 5.2. It can be found here. There is only one minor change to the User Guide, which is to reflect the new thresholds for workers’ compensation, liability and no-fault claims which CMS had announced back in November. For our prior blog on the updated thresholds which were announced in … Read more »

CMS to Hold Open Door Forum Regarding Impact of Removal of SSN numbers to MMSEA Section 111 Reporting

Heather Sanderson Blog, Medicare Jurisdiction, Medicare Secondary Payer News No Comments

On the heels of CMS’ announcement from May 2016 that it was taking steps to comply with the Medicare Access and CHIP Reauthorization Act (MACRA), which requires CMS to remove SSNs from Medicare ID cards by April 16, 2019, CMS has announced an Open Door Forum call to address how this change would impact Section 111 processes. More information on the … Read more »

WCRC Solicitation Released: Liability and No-Fault MSAs on the Horizon for 2018

Heather Sanderson Administration, Blog, LMSA, Medicare Set Aside, WCMSA No Comments

As a follow-up to our recent blogs regarding a change in the Workers’ Compensation Review Contractor (WCRC) and the new WCRC reviewing Liability Medicare Set-Asides (LMSAs), CMS has now released the official solicitation for the award. The solicitation can be found here, and our latest prior blog on this topic can be found here. The solicitation states that proposal bids are due … Read more »