Cases & Points Blog

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 […]

CMS Hosting PAID Act Webinar

The Centers for Medicare and Medicaid Services (CMS) announced today that they will be hosting a PAID Act webinar on June 23, 2021 at 1 PM ET.  This alert is located on the CMS NGHP website What New page and can be found here.  CMS states that the webinar will cover “what the PAID Act […]

Going Down the Rabbit Hole Post Settlement: What Can Medicare Do?

By P. Czuprynski The Medicare Secondary Payer Act (MSP) identifies Medicare is supposed to be second in line for payment if there is a non-group health plan that covers a certain date of incident or claimed medical expenses (i.e. workers’ compensation, liability or no-fault claim). What this means is if Medicare made payment, but the […]

CMS Releases Updated WCMSA Reference Guide 3.3

CMS has released a new version of the Workers’ Compensation Medicare Set-Aside (WCMSA) Reference Guide, 3.3, COBR-Q2-2021-v3.3 dated April 19, 2021. The new Guide includes additional language regarding the calculation of the seed money for structured settlements. When a structured WCMSA is utilized by the parties, in addition to annual payments, a calculation of the […]

Updated Section 111 NGHP Model Language

CMS has released an updated Section 111 Model Language form to assist Responsible Reporting Entities (RREs) in obtaining critical information needed to determine claimants’ Medicare eligibility status.