Author Archives: BSmith

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The PAID Act Becomes Law

The Provide Accurate Information Directly (PAID) Act, has been passed by the U.S. Congress and was signed by President Trump on December 11, 2020.   The purpose of the PAID Act is to address the lack of a centralized process to identify Medicare Advantage Plan and Medicare Part D Prescription Drug Plan beneficiaries.  Currently, the Section […]

CMS News to Note

November was a busy month for CMS with the issuance of a new NGHP User Guide, Version 6.1 and multiple alerts.  Below is a brief summary of these updates.  2021 Recovery Threshold Alert On November 25, 2020, CMS issued a new alert on the 2021 Recovery Thresholds beginning on January 1, 2021.  The alert notes […]

CMS Issues Section 111 NGHP User Guide Version 6.0

The new Section 111 NGHP User Guide 6.0 (Guide) was issued by CMS on October 5, 2020 and contains several updates as noted below. Chapter III, Section 4.6 of the Guide, CMS has specified what items should be included when calculating the Total Payment Obligation to Claimant (TPOC).  CMS notes that the “TPOC amount includes, […]

New WCMSA Reference Guide 3.2 Issued by CMS

On October 5, 2020, CMS issued a new WCMSA Reference Guide (Guide) version 3.2.  Changes to the Guide include defining what major medical centers the Workers’ Compensation Review Contractors (WCRC) utilize for pricing surgical interventions in WCMSAs.  A copy of the new Guide can be found here. Specifically, CMS added a new Appendix 7 to […]

CMS Releases Documents from Section 111 NGHP Webinar

As a follow-up to the Section 111 NGHP webinar held on August 13, 2020, CMS has now released the slides from the webinar as well as the answers to various questions posed after the presentation.  NuQuest posted a prior blog on the highlights from this presentation which can be found here. Should you have any […]

New CMS Alert on Section 111 Webinar Presentation

CMS has released the August 13, 2020 Section 111 Non-Group Health Plan Reporting webinar presentation.  The presentation can be accessed on the download section of the Mandatory Insurer Reporting for Non-Group Health Plans What’s New page or through the following link: _https://www.cms.gov/files/document/august-13-2020-section-111-non-group-health-plan-reporting-webinar-presentation.pdf.  Questions and answers from the webinar will also be released by CMS in […]

CMS Issues New Section 111 Alert

Jun 12, 2020 by Bridget Smith, JD CMS Issues New Section 111 Alert for Reporting No-Fault Insurance Limit on Non-Group Health Plan (NGHP) Claim Input Files In this Alert dated June 8, 2020, CMS  reminds Non-Group Health Plan (NGHP) Responsible Reporting Entities (RREs)  that when reporting No-Fault Insurance Limits via Section 111 both Med Pay […]

CMS Issues New WCMSA Reference Guide 3.1

May 19, 2020 by Bridget Smith, JD CMS has released a new Workers’ Compensation Medicare Set-Aside Reference Guide, Version 3.1, May 11, 2020, COBR-Q2-2020-v3.1 a link to which can be found here:  https://www.cms.gov/files/document/wcmsa-reference-guide-version-31.pdf  This version of the Guide contained the new reference to  the CDC life table 2017 that CMS has been utilizing for the […]