Cases & Points Blog

Barbara Fairchild awarded National Programs and Services Division Office MVP

We wanted to share the exciting news! What an accomplishment! 

Section 111 Non-Group Health Plan (NGHP) Reporting Webinar – Thursday, August 13, 2020

On Thursday, August 13, 2020, CMS will be hosting a webinar for Non-Group Health Plan (NGHP) Liability Insurance (including Self-Insurance) No-Fault and Workers’ Compensation Section 111 Reporting entities.  CMS will provide initial opening remarks followed by a presentation which will include best practice and reminders.  Questions for the webinar can be mailed to: Section 111 […]

CMS issues updated Non-Group Health Plan (NGHP) User Guide regarding Section 111 Reporting, Version 5.9

July 6, 2020 by Patrick Czuprynski, JD, MSCC, CMSP On 6/29/2020, Medicare issued an update to its NGHP User Guide. The following is a summary of those updates: Chapter III: Policy Guidance Sections 6.4.2, 6.4.3 and 6.4.4 were updated to remind Responsible Reporting Entities(RRE) that the $750 settlement reporting threshold does not apply to liability […]

Updated Time Frame for Future Medical Proposed Rule Making

Pursuant to the notification issued on the Office of Information and Regulatory Affairs OMBt website, the proposed rule to address future medicals in liability, no-fault and workers’ compensation cases has been pushed for release to August 2020. The proposed rule entitled Miscellaneous Medicare Secondary Payer Clarification and Updates (CMS-64047) was originally scheduled for release 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 […]

CMS Publishes Public Comments to Proposed Section 111 Civil Monetary Penalties Rule

 – May 13, 2020 by Bridget Smith CMS received over 80 public comments in response to the Medicare Secondary Payer and Certain Civil Monetary Penalties Proposed Rule that was issued in February of this year.  Although the comments differed in some respects, there were clearly some overarching themes and issues that CMS should address.  Comments […]

Today is the Day!

April 1, 2020 – As of today, CMS will no longer be accepting Consent to Release Notes that do not include the following additional language: “Further, I have had the Workers’ Compensation Medicare Set-Aside Arrangement need and process explained to me, and I approve the contents of the submission.  Beneficiary initials_______.” If you have Workers’ […]

CMS Updates Regarding MSP Compliance Operations

March 25, 2020 – NuQuest has reached out to CMS to confirm operation functions for both conditional lien recovery and Workers’ Compensation Medicare Set-Aside submissions and approvals.  In addition, to our prior blog posting regarding CMS accepting electronic signatures that comply with the ESIGN Act, CMS has also confirmed the following: The WCRC is fully […]

Medication Pricing Updates

March 24, 2020 – The Red Book Average Wholesale Price (AWP)  for Meloxicam 7.5mg and 15mg is currently listed at $0.05 per pill.  This is a significant decrease from the prior listing price of $4.25 per pill.  If you have a WCMSAs that have not been submitted for CMS review or a NuShield MSA and […]