Our Insights

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 least. This proposed rule, believed to set possible parameters for Liability and No-Fault Medicare Set-Asides, has […]

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 […]

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. According to the Alert disseminated today by the […]

Common Medicare Secondary Payer question: When is a Medicare Conditional Payment due? When the mail delivers anything with CMS letterhead prominent in the top left-hand corner, most payers recognize it needs some attention, particularly given the countless horror stories circulated within the insurance industry associated with failure to reimburse CMS. But there are so many […]

In the fourth iteration of the NGHP Section 111 User Guide in six months, CMS has issued several updates, mainly affecting technical aspects of Section 111 reporting. The bulk of these updates attempt to clarify how and when errors will be received through the reporting process. As we know, the proposed regulations regarding civil monetary […]

Set your calendars for 1 PM, Thursday April 1, 2021 to hear from CMS in a Town Hall about “common NGHP topics.” In an alert dated February 25, 2021, CMS stated that representatives from the Centers for Medicare and Medicaid Services, the Benefits Coordination & Recovery Center (BCRC) and the Commercial Repayment Center (CRC) will be on […]