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, Medicare Jurisdiction, Medicare Reporting Section 111

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 …
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Administration, Blog, LMSA, Medicare Set Aside, WCMSA

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 …
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CMS Announces Intent to Enhance Re-Review Process in 2017

11 Jan 2017 Heather Sanderson No Comments

Blog, Medicare Set Aside, WCMSA

Yesterday, CMS issued an Alert which states the following (the alert can be found here): The Centers for Medicare & Medicaid Services recently revisited the task of reviewing its process for addressing requests for CMS to “re-review” otherwise approved Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) amounts. In Calendar year 2017, CMS expects to update its existing re-review process to address …
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Blog, Medicare Secondary Payer News, Medicare Set Aside, WCMSA

We recently blogged that CMS delayed the Workers’ Compensation Review Contractor (the entity that reviews Workers’ Compensation Medicare Set-Asides) award to the 2ndquarter of 2017, with the solicitation being released in the 1st quarter. For our prior blog, click here. CMS has now released their draft Request for Proposal (RFP) as well as draft Statement of Work (SOW) for the Contractor.  While it is …
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Blog, Medicare Set Aside, WCMSA

According to the Court of Appeals of North Carolina, a WCMSA was not considered a “countable resource” for purposes of determining a claimant’s Medicaid eligibility, Williford v. North Carolina Department of Health and Human Services, 2016 N.C. App. LEXIS 1163 (November 15, 2016). The basic facts of the case involve a 68-year-old widow (Ms. Williford), who suffered a work injury …
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