Blog, Medicare Conditional Payments

Prior to 2013, insurance carriers did not have the same appeal rights as beneficiaries and if Medicare made an incorrect determination as to a primary plan’s responsibility for conditional payments, the primary plan was stuck with the responsibility to pay and without further recourse. However, the SMART Act, promulgated by the MARC Coalition, and signed into law by President Obama …
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Blog, Medicare Reporting Section 111, ORM, RRE, TPOC

We recently blogged regarding CMS releasing their updated NGHP User Guide version 5.3. The primary change outlined in the Summary of Changes in the User Guide was regarding CMS’ SSNRI initiative which will ultimately replace the use of SSN’s with MBIs. For more information, our prior blog can be found here. It appears that CMS has also modified another section of …
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CMS Releases Updated NGHP User Guide Version 5.3

27 Dec 2017 Heather Sanderson No Comments

Blog, Legal/Legislative News, Medicare Conditional Payments, Medicare Reporting Section 111, Medicare Secondary Payer News

CMS has released an updated Non-Group Health Plan (NGHP) User Guide version 5.3. It can be found here. The primary change to the User Guide involves detailing CMS’ transition with its Social Security Number Removal Initiative (SSNRI) and how this transition will impact MMSEA Section 111 Reporting. The SSNRI initiative mandates CMS to replace all SSN-based Medicare identifiers and distribute a …
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Blog, Medicare Conditional Payments, Medicare Secondary Payer News, 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. Last year in 2016, CMS announced that the threshold would be $750 across all non-group health plan (NGHP) lines of business- workers’ compensation, liability, and no-fault insurance. The threshold means that if the …
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Blog, Legal/Legislative News, LMSA, Medicare Conditional Payments, Medicare Set Aside, WCMSA

The United States District Court for the District of New Mexico has issued an interesting decision involving the uncertainty for the need of a Liability Medicare Set-Aside (LMSA) in a medical malpractice settlement involving a Medicare beneficiary. The case is captioned Silva v. Burwell, 2017 U.S. Dist. LEXIS 195032 (November 28, 2017). A copy of the decision can be found …
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Blog, LMSA, Medicare Set Aside

Liability Medicare Set-Asides (LMSAs) and No-Fault MSAs (NFMSAs) Update: We recently issued a blog that CMS withdrew/rescinded a MedLearn article to medical providers which directed medical providers to bill a LMSA/NFMSA where a Medicare beneficiary has received a Medicare Set-Aside as part of a liability, no-fault or workers’ compensation settlement, judgment or award (instead of Medicare).  While the MedLearn article …
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