Cases & Points Blog

The New WCMSA Reference Guide Version 3.5 “Clarification” Regarding Evidence-Based MSAs

by B. Smith The Centers for Medicare and Medicaid Services (“CMS”) issued an updated Workers’ Compensation Medicare Set-Aside Arrangement (“WCMSA”) Reference Guide (the “Guide”), Version 3.5, dated January 10, 2022. As noted by CMS, changes to the Guide includes “clarification” regarding “non-CMS-approved products to address future medical care” which can be found in Section 4.3. […]

New Section 111 TPOC Alert Issued by CMS

by B. Smith CMS issued a new alert regarding the requirement to complete the Funding Delayed Beyond TPOC Start Date field in applicable situations. Specifically, the alert is a reminder that if funding is delayed after the settlement date and the TPOC Date in Field 80 has been reported, Responsible Reporting Entities  (RREs) should also […]

CMS Issues New Alert Regarding Incorrect Reporting of No-Fault Policy Limits

By B. Smith On October 26, 2021, CMS issued an alert addressing the importance of accurately reporting no-fault policy limits as part of Section 111 Reporting. CMS acknowledged that policy limits may vary based upon state law or contract terms. In these situations, CMS notes that the reported policy limit “should reflect the actual amount […]

New WCMSA Reference Guide

CMS has issued an updated Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide, Version 3.4. The Guide has several minor changes including CMS’s focus on the receipt of appropriate settlement documents for the approval of the WCMSA.  Specifically, in Section 10.5 and in various sample letters in Appendix 5, CMS notes that “approval of the […]

Section 111 PAID Act Updates

On September 9, 2021, CMS hosted another webinar to discuss upcoming changes to the Section 111 query process.  These changes are being made to comply with the provisions of the PAID Act which requires CMS to provide enrollment information for Medicare Part C and Part D plans.  The following are some of the key highlights […]

CMS to Host PAID Act Webinar

On September 9, 2021,  CMS will be hosting a Provide Accurate Information Directly (PAID) Act testing webinar.  Webinar details can be found here. Should you have any questions regarding the PAID Act and the impact it will have on the Section 111 query process, please contact the NuQuest Settlement Consultants at: [email protected]  

CMS Releases PAID Act Presentation

The presentation from the June 23, 2021 PAID Act Webinar is now available in the download section of the NGHP What’s New page.  A link to the presentation can be found here.   Please see our prior blog by clicking here with a summary of the presentation highlights.  If you have any question regarding Section 111 […]

Conditional Payments: Is Medicare’s Reopen Process Right for You? Which Regulation Can Medicare Ignore?

On November 17, 2016, Medicare states the following during a townhall presentation, click here for link to transcript. As many of you may be aware the CRC systematically filters all claims before issuing CPLs, CPNs and Demand letters so that the conditional payments specifically sought for recovery are related to the No-Fault insurance or Workers’ […]

Key Highlights from CMS’ PAID Act Webinar

On June 23, 2021, CMS hosted a webinar to review changes that will be made to the Section 111 query process in response to the requirements of the PAID Act.  As discussed in our prior blog postings​, which can be found here, beginning December 11, 2021, the CMS query response data will include additional information […]

CMS Issues New Section 111 NGHP User Guide and PAID Act Technical Alert

CMS has been very busy this month.  In addition to the webinar scheduled for June 23, 2021 to discuss the Provide Accurate Information Directly (PAID) Act.  CMS has now issued a new NGHP User Guide and a PAID Act technical Alert.  The User Guide and the Alert contain significant substantive and technical changes regarding ORM […]