Category Archives: TPOC

NGHP User Guide Version 5.2 Released

11 Jan 2017 Heather Sanderson No Comments

Blog, Medicare Reporting Section 111, TPOC

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 …
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Blog, Legal/Legislative News, Medicare Reporting Section 111, 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. For the past three (3) years, the liability TPOC threshold has been maintained at settlements of $1000 or less. CMS has announced via alert that the TPOC threshold for liability claims will remain …
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Blog, Medicare Reporting Section 111, TPOC

In a move that was expected, on February 28, 2014, CMS issued the attached Alert clarifying the $1,000 / $2,000 issue we identified in our recent blog.  The MIR threshold for TPOC’s in liability settlements remains at $2,000 until October 14, 2014 when it is reduced to $1,000.  Settlements below $1,000 are exempt from conditional payment development.   This means that for the …
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Blog, Medicare Reporting Section 111, TPOC

Last month, CMS issued version 4 of the MMSEA Section 111 User Guide.   The purpose of the Guide is to provide Responsible Reporting Entities (RREs) with necessary guidance to comply with Medicare Secondary Payer data reporting rules that have been in force for some time.  As a refresher, RREs were required to begin reporting Ongoing Responsibility for Medicals as of …
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Medicare Reporting Section 111, Medicare Secondary Payer News, TPOC

On June 20, 2012, the CMS issued an alert with a new schedule for reporting of liability TPOC dates and amounts pursuant to Section 111. The new schedule is as follows: Total TPOC Amount TPOC Date On or After Section 111 Reporting Required in the Quarter Beginning TPOCs over $100,000 October 1, 2011 January 1, 2012 TPOCs over $50,000 April …
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Blog, Medicare Reporting Section 111, ORM, TPOC

By Katie A. Fox, MSCC Last Friday, the Centers for Medicare & Medicaid Services (CMS) issued an alert extending the mandatory reporting period for Liability cases with a Total Payment Obligation to Claimant (TPOC) only.  We wrote yesterday about the positive effect this would have on the liability industry struggling to get its data systems ready for reporting.   However, the alert also …
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CMS EXTENDS MANDATORY REPORTING FOR LIABILITY CASES

15 Nov 2010 Roy Franco No Comments

Blog, Medicare Reporting Section 111, ORM, RRE, TPOC

Franco Signor LLC – November 15, 2010 Centers for Medicare and Medicaid Services (CMS) issued new liability reporting rules in an alert on November 9, 2010. Click here for the Alert.  Responsible Reporting Entities (RRE) may now voluntarily report liability settlements, awards and judgments, without penalty, beginning next year. Mandatory liability reporting is now slated to start January 1, 2012, …
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Notifying Medicare. 42 CFR 411.25. $5k Threshold?

08 May 2010 Jeff Signor No Comments

Blog, Medicare Reporting Section 111, TPOC

Notifying Medicare in EVERY settling claim involving a Medicare beneficiary is a best practice that Franco Signor LLC recommends. Notification needs to occur now, on a regular basis, because the focus on Medicare’s unfunded liability is politically toxic.
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