Medicare Recovery Efforts May Increase

As what remains of 2022 dwindles into a new year, trending on the Medicare Conditional Payment front garners attention from industry stakeholders. Mounting concerns surrounding Civil Monetary Penalties associated with Section 111 Medicare Mandatory Insurer reporting (rulemaking anticipated by or before February 2023) could increase vigilance and reporting efforts. Additionally, a recent OIG audit, which coupled with procurement for various contractor positions administering the Medicare Secondary Payer program, pose changes for the last quarter of 2022 and into 2023.
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CMS Alert! CMS to Host Workers' Compensation Medicare Set-Aside Webinar

CMS published an Alert indicating it will be hosting a webinar to discuss a variety of WCMSA topics, including a summary of what's new in Medicare set-asides, and addressing questions related to the inclusion of treatments, application of state rules, re-reviews/amended reviews and more.
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CMS Launches 'Go Paperless' Option for MSPRP Account Holders

CMS will now provide RREs, as well as their Recovery Agents, with the option to go paperless with respect to Medicare recovery correspondence. In an updated NGHP Section 111 User Guide release, version 6.7, CMS states that insurers and their recovery agents may elect to receive electronic correspondence so long as a Medicare Secondary Payer Portal (MSPRP) account has been set up.
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CMS Discredits Non-Submits in WCMSA Reference Guide Version 3.5

Whether or not to submit has through the years been touted as the main event at dozens of national conferences and seminars, promoting these sessions like MSP cage-match battles, pitting experts against one another in impassioned debate. Today Medicare put to rest more than a decade of MSP industry contention regarding whether Workers’ Compensation Medicare Set-Asides meeting Medicare’s published review thresholds must be reviewed and approved to establish validity and afford protection to Beneficiaries’ future Medicare entitlements. The decision is in and the answer is yes.
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2022: LMSA Pushed to February, $750 Threshold Remains

It’s beginning to look a lot like LMSA rules aren’t happening in 2021. So if this was your wish from Santa, you must be on The Naughty List. This week, the Office of Information and Regulatory Affairs (OIRA) updated the timeframe from October 2021 to February of 2022. And for all of the “Nice” primary payers, beneficiaries, attorneys and insurance professionals, CMS kept its $750 minimum recovery threshold in place for the coming year.
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Section 111 Reporting Update

Over recent weeks, CMS has posted a duo of alerts to the Non-Group Health Plan Mandatory Insurer Reporting landing page. While these alerts do not place any new obligations or requirements on Responsible Reporting Entities, they do provide some helpful reminders, coupled with a bit of guidance.
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PAID Updates Added to Companion Guide Version 5.7

CMS has published an updated Benefits Coordination & Recovery Center (BCRC) 270/271 Health Care Eligibility Benefit Inquiry and Response Companion Guide for Mandatory Reporting Non-GHP Entities Version 5.7.
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More PAID Act Updates 9/9

On September 9, 2021, CMS will host its second informational webinar relative to the PAID Act. Per CMS’ Alert dated August 9, 2021, the webinar “will offer important PAID Act reminders and focus on the details of the upcoming testing period, which will begin on September 13, 2021.” As with the roll-out webinar of June 23, 2021, a live question and answer session with both CMS staff and the Benefits Coordination and Recovery Center (BCRC) will follow.
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Wait for it ... Again: LMSA Rules in October?

In yet another push into the future, the Office of Information and Regulatory Affairs (OIRA) Dashboard today indicates that any possible Notice of Proposed Rulemaking regarding Medicare Secondary Payer and Future Medicals (CMS-6047) will not occur until October of 2021, at the earliest.
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CMS UPDATE: New Section 111 User Guide Released with PAID Act Information

Two weeks in advance of its PAID Act webinar, CMS has released an updated NGHP Section 111 User Guide.  While the latest version contains several updates, the most intriguing and most impactful may be the announcement that the changes to the Medicare entitlement information provided via the Section 111 query process outlined by the PAID Act will be effective December 11 of this year.
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CMS to Debut PAID Act Details in Webinar on June 23rd

On June 23, 2021, Medicare will debut details relative to the PAID Act (Provide Accurate Information Directly), a new law designed to help Non-Group Health Plan (NGHP) Responsible Reporting Entities (RREs) better coordinate benefits by providing them with Medicare Beneficiary Part C and Part D enrollment information.
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This is not a bill: NC District Court addresses ripeness...

Common Medicare Secondary Payer question: When is a Medicare Conditional Payment due?
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MSP Admissions Questionnaire and it's impact on the MSP system overall...

On September 15, 2020, the Centers for Medicare and Medicaid Services (CMS) published changes to the MSP Admissions Questionnaire found in the previous manual. The changes went into effect on December 7, 2020.
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Section 111 User Guide Update

NGHP Section 111 updated user guide was published. Check out the changes and read more below!
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One Week Reminder: Town Hall on NGHP Conditional Payments and Section 111 Reporting

Set your calendars for 1 PM, Thursday April 1, 2021 to hear from CMS . . .
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New Year, New Section 111 User Guide

CMS has started off 2021 with a bang. As we have seen over recent months, CMS has been rapidly updating the NGHP Section 111 User Guide, releasing version 6.0 on Oct. 5, 2020 quickly followed by version 6.1 on November 10, 2020, and now version 6.2 in January. Unlike some past iterations of the User Guide, this release provides a few crucial updates that could affect RREs in a big way.
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CMS Releases Updated NGHP Section 111 User Guide Providing Needed Clarity

On October 5, 2020 CMS issued an updated version of the of the MMSEA Section 111 NGHP User Guide. The latest version of the User Guide, version 6.0, clarifies the computation of TPOC amounts, confirms the fact that indemnity-only settlements do not need to be reported, and provides an updated list of excluded ICD codes for 2021.
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Double the Damages, Double the Motion, Double the Denial

MSP Double Damages action to continue despite SoL and settlement release arguments
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