Cases & Points Blog

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Official Release of CMS Proposed Rule on Section 111 Civil Monetary Penalties

February 18, 2020 – As anticipated, the proposed rule outlining when CMS would impose civil monetary penalties or as they are now referred to as CMPs, was officially published today in the Federal Register.  The text of the proposed rule can be found here The proposed rule impacts both Group Health Plan entities (GHP) […]

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New CMS Coverage Determination

January 23, 2020 – On January 21, 2020, CMS issued a decision memo for coverage of acupuncture treatments for the treatment of chronic low back pain.  Specifically, the Decision Memo for Acupuncture for Chronic Low Back Pain (CAG-00452N) states in pertinent parts as follows: A.  The Centers for Medicare & Medicaid Services (CMS) will cover […]

Medicare hosts Town Hall 1/14/2020: Non-Group Health Plan

January 16, 2020 – On 1/14/2020, Medicare hosted a town hall meeting to explain certain aspects of its collection process and also set time aside for a Q&A session. During the presentation, Medicare provided information regarding:  Medicare’s collection process using Section 111 reporting information, CRC’s optional Pre Conditional Payment Notice process and the open debt […]

NuQuest Negotiation Saves $119,000.00

January 15, 2020 – NuQuest recently obtained a favorable response from a BCRC demand (Medicare’s collection based upon settlement). Medicare removed $119,000.00 in charges. It is Medicare’s burden to demonstrate their payments require reimbursement.  NuQuest reviews each date of service listed in Medicare’s payment summary form and makes a determination if a date of service […]

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Medicare Advantage Plan Obtains Victory on Conditional Payment Recovery in Ohio

Recently, the Northern District of Ohio issued decisions regarding a Medicare Advantage Plans right to seek reimbursement for conditional payments: MSP Recovery Claims, Series LLC v. Phoenix Insurance Company, 19cv00436, (motion to dismiss denied 12/12/2019); MSP Recovery Claims, Series LLC v. Grange Insurance Company, 19vc00219, (motion to dismiss denied 12/12/2019); MSP Recovery Claims, Series LLC […]

CMS Issues 2020 MSP Recovery Thresholds

On November 27, 2019, CMS issued the 2020 Recovery Thresholds for Certain Liability Insurance, No-Fault Insurance, and Workers’ Compensation Settlements, Judgements, Awards, or Other Payments. Starting January 1, 2020 physical-based liability insurance settlements will remain $750.  For no-fault and workers’ compensation settlements that do not include ongoing responsibility for medical, the threshold will also remain […]

CMS Issues NGHP Alert Regarding Medicare Beneficiary Identifier Reporting

Pursuant to the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, CMS replaced beneficiary Medicare cards containing Social Security based Health Insurance Claim Numbers (HICN) with a new unique Medicare Beneficiary Identifier (MBI).  Although MBIs will officially be utilized by CMS January 1, 2020,  MACRA does provide an exemption for the use SSN based […]

CMS Issues New WCMSA Reference Guide 3.0

From new language added to Consent to Release forms to a focus on professional administration, CMS’ new User Guide contains some important substantive and procedural changes. Recommended Professional Administration of WCMSA Accounts: Section 17.1 has been updated to include Medicare’s recommendation to professionally administer MSA’s that include “Frequently Abused Drugs” as defined by CMS’ Part […]

CMS Issues New Self-Administration Tool Kit

CMS has issued a new Self-Administration Tool Kit for Workers’ Compensation Medicare Set-Aside Arrangements (WCMSA) version 1.3.  Changes from the prior version of the Tool Kit  include new information on the enhancement of the WCMSA Portal allowing the beneficiary,  his/her representative, or other identified administrator to electronically file yearly attestation statements.  In addition, Section 10 […]

Medicare Compliance Spooktacular

In this Halloween edition of our NuQuest blog we highlight some of the tricks and treats that have been passed down to us by CMS in 2019.  Tricks LMSAs/No-Fault MSAs Proposed Rulemaking for LMSA/No-Fault cases was originally set to be released in September 2019.  This was then pushed back to October 2019.  Although the month/year […]