12 Feb 2018 Heather Sanderson No Comments
Blog, Medicaid Third Party Liability Recoveries
As we have discussed in numerous blogs and webinars, Medicaid Third Party Liability (TPL) operates at a state level. For a more detailed explanation on Medicaid TPL, click here. In summary, the Centers for Medicare & Medicaid Services (CMS) has required each state to implement TPL legislation and regulation surrounding the recovery of medical payments made by Medicaid, where a …
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12 Feb 2018 Jesse Hamby No Comments
Blog, Medicare Conditional Payments
Just a reminder that the new Commercial Repayment Center (CRC) contractor goes live today. Click here to read our recent blog on the topic. Click here to download a CRC – NGHP Correspondence Cover Sheet.
01 Feb 2018 Jesse Hamby No Comments
Click here to register to view the recording. Join Roy Franco and Heather Sanderson for their first live/video webinar event on January 31st at 1:30 PM EST. Roy and Heather will be taking on the hot topic of LMSAs, and what payers should be doing right now to gear up for the likelihood of CMS introducing a review policy for …
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Blog, Medicare Advantage Part C
Recall that in September 2016, the Eleventh Circuit Court of Appeals ruled that Humana Medicare Advantage may sue a primary plan for failure to reimburse conditional payments under the Medicare Secondary Payer (MSP) private cause of action for double damages. The Eleventh Circuit encompasses the jurisdictions of Florida, Alabama, and Georgia. For our original blog on the Eleventh Circuit Western …
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23 Jan 2018 Roy Franco No Comments
Blog, Legal/Legislative News, Medicare Advantage Part C
Previously, we blogged on the “System” created by MSP Recovery LLC to identify potential primary payers in Medicare Advantage Plan (MAO) conditional payment recovery claims. The Plaintiff, MSP Recovery LLC, testified that they created this unique “System” using the following databases; ISO reports, state car crash databases, MAO claim data, and others. MSP Recovery has now secured a preliminary $5M settlement in court …
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19 Jan 2018 Heather Sanderson No Comments
Blog, Medicare Conditional Payments
Yesterday, January 18th, the Centers for Medicare & Medicaid Services (CMS) conducted a webinar for Non-Group Health Plans (NGHPs) to discuss the transition of the new Commercial Repayment Center (CRC) contractor from CGI Federal to Performant Financial Corp. On January 17th, a similar webinar was conducted for Group Health Plans (GHPs) with respect to the transition. Ted Doyle, the Project …
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