The OMB Issues Intent of Notice of Proposed Rule Making for Section 111 Penalties

In an abstract entitled “Civil Money Penalties and Medicare Secondary Payer Reporting Requirements,” the Office of Management and Budget has issued another intent of Notice of Proposed Rulemaking this time involving Section 111 Reporting penalties.  Specifically, the abstract of the Notice provides as follows:

Section 516 of the Medicare Access and CHIP Reauthorization Act of 2015 amended the Social Security Act (the Act) by repealing certain duplicative Medicare Secondary Payer reporting requirements. This rule would propose to remove obsolete Civil Money Penalty (CMP) regulations associated with this repeal. The rule would also propose to replace those obsolete regulations by soliciting public comment on proposed criteria and practices for which CMPs would and would not be imposed under the Act, as amended by Section 203 of the Strengthening Medicare and Repaying Taxpayers Act of 2012 (SMART Act).

Pursuant to the SMART Act, civil penalties for non-compliance with Section 111 are up to $1,000 per day, per claimant.  However, no official guidance regarding how these penalties will be determined and enforced has been issued by CMS.  Similar to the Notice issued by the OMB we reported on last week involving Liability Medicare Set-Asides, action to be taken on the Notice of Proposed Rulemaking is set to take place in September 2019.  NuQuest will continue to keep you abreast of any additional developments as they become available.  For  further questions regarding this Notice or for any of your Medicare compliance needs, please contact the NuQuest Legal Team.

Success in the CMS Re-Review Process

Pursuant to Section 16.0 of the Workers’ Compensation Medicare Set Aside (WCMSA) Reference Guide, Version 2.8, October 1, 2018, COBR-Q4-2018-v2.8, CMS will conduct a Re-Review of a prior WCMSA determination in certain circumstances.  Specifically, CMS will complete this process in cases involving a mistake in the allocation; mathematical error; or when there is missing documentation that pre-dated the WCMSA submission date that could change its value.  CMS will also perform an Amended Review when there are changes to the WCMSA that post-date CMS approval and the case meets certain criteria.  Knowing when and how to use the appropriate Re-Review process is imperative in helping to prevent inaccurate or over-inflated WCMSAs.

One recent example of NuQuest successfully utilizing the appropriate Re-Review option involved an appellate court order that was issued after the date of the WCMSA submission.  The case involved whether claimant required ongoing treatment for a work-related lumbar spine injury.  The appellate court determined that the description of injury was an aggravation of a lumbar sprain and claimant’s intervening injuries as well as a gap in treatment evidenced that claimant’s work injury had resolved.  Highlighting the timeline of the appellate process; the court’s rationale; medical evidence; and the nature of injury, NuQuest was able to successfully advocate for a zero dollar WCMSA.  This resulted in over an $18,000 savings to the client.

Critical review of a WCMSA to determine if a Re-Review is warranted is a necessary part of the Medicare compliance process.  However, identifying these issues is only one part of the equation.  Knowing the appropriate arguments to include in a Re-Review as well as the appropriate mechanism to make this request is equally important to obtain a successful result.

For further information regarding WCMSAs or any Medicare compliance needs, please contact the NuQuest Legal Team.

Client Realizes Half Million in Savings with NuQuest Re-Review

NuQuest strives to save our clients’ money, even years after the original settlement. One example is how a claim that was recently amended saved our client $567,706. Although the original CMS approval in January 2015 was for $780,736, a CMS Amended Review was requested by our client, due to a change in the treatment plan. Our updated review reduced the claim amount to $213,030, and the amended proposal was approved by CMS.

Our clients choose NuQuest as their trusted Medicare and MSP Compliance partner because we have a reputation for honesty and dependability. Over the years, we have assembled a core of specialists with industry-leading expertise in the areas of medicine, law and benefits. Contact us today to discover the NuQuest difference.

Commercial Repayment Center (CRC) Transition Webinar Available

In January, the Centers for Medicare and Medicaid Services (CMS) held a webinar discussing the transition of the Commercial Repayment Center’s (CRC) operating contractor from CGI Federal to Performant Financial Corporation for Group Health Plans and Non-Group Health Plans.  The slides for the webinars are now available on CMS’ website.  The Non-Group Health Plan presentation may be found here. The Group Health Plan presentation may be found here.

A summary of the presentation can also be found through our “Cases and Points Blog” or by clicking here.

Commercial Repayment Center (CRC) Transition Update:

The Centers for Medicare and Medicaid Services (CMS) recently held a webinar discussing the transition of the Commercial Repayment Center’s (CRC) operating contractor from CGI Federal to Performant Financial Corporation (Performant) for Group Health Plans and Non-Group Health Plans.

During the transition, there will be “dark days” where CRC will not be operating, but transferring files from CGI Federal to Performant.  These dark days begin on Friday, 2/9/2018 at 8 pm and end on Monday, 2/12/2018 at 8 am EST.  On 2/12/2018, Performant Financial Corporation will be operating the CRC.

Performant has provided two contacts for use with respect to the transition:

Ted Doyle – CRC Transition Project Director            Laura Martinez – MSP CRC NGHP Recovery Manager
(925) 337-5558                                                                  (209) 858-3705
tdoyle@performantcorp.com                                       lmartinez@performantcorp.com

Additionally, Performant has provided the following email to be used for claims with special needs:  CRCNGHPInquiries@performantcorp.com

Beginning 2/12/2018, all NGHP CRC correspondence and checks should be sent to:

Medicare Commercial Repayment Center – NGHP
PO BOX 269003
Oklahoma City, OK 73126

*New fax number (844) 315-7627

Fax Number: CRC’s current fax number will be disconnected on 2/6/2018 at 8 pm, the new number begins operation at 8 am on 2/12/2018.

Customer Service Line: telephone number stays the same (855) 798-2627. The phone line will be turned off at 8 pm on 2/9/2018.  Performant to begin its operation at 8 am on 2/12/2018.

All data is being “frozen” at the end of the day on 2/7/2018.  This means no new information or data will be uploaded onto the web portal or into CRC’s system until Performant starts entering the data on 2/12/2018 at 8 am.

All pending appeals will be transferred to Performant during the dark days, to assume handling.  The timeframe for response does not change and Performant requests the industry continue with their regular follow up time-frames.  (i.e. don’t call to see if an appeal with CGI was received by Performant).

Mail sent to the old CRC address will be forwarded to the new PO BOX, however, beginning 2/12/2018, the new PO BOX should be used.  If mail is sent to Performant before 2/12/2018, Performant will hold the mail and start processing beginning 2/12/2018 8 am.