Cases & Points Blog

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.

CMS BCRC and CRC NGHP Town Hall Updates

On April 1, 2021, CMS held its scheduled Town Hall with the Benefits Coordination & Recovery (BCRC) and Commercial Repayment Center (CRC) for Non-Group Health Plans (NGHP).  Although parts of the Town Hall included information that was already disseminated by CMS in the past, there were some specific highlights as noted below. Partial Resolution of […]

CMS Updates Life Tables for WCMSAs

Beginning March 27, 2021, CMS will convert to  the CDC’s “Table 1: Life Table for the total population: United States, 2018” for all Workers’ Compensation Medicare Set-Aside life expectancy calculations.  A link to the 2018 Life Tables can be found here.  The life tables are used by CMS to calculate the length of medical treatment […]

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Interplay: Section 111 Reporting and Conditional Payments

The Medicare Secondary Payer Act (MSP) and Medicare’s Section 111 User Guide require a carrier/self-insured to report to Medicare, when appropriate: Ongoing Responsibility for Medical (ORM); OR Settlement, judgement, award or other payment These requirements allow Medicare to perform three actions when presented with a medical payment that may be associated with a workers’ compensation, […]

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CMS NGHP User Guide 6.2

In less than four months, CMS has issued three revised versions of the Non-Group Health Plan (NGHP) Section 111 User Guide.  The most recent version, Guide 6.2, includes some of the following updates: In Chapter IV, Section 6.7.1 of the Guide, CMS notes that those Responsible Report Entities (RREs) who can identify a future Ongoing […]

CMS Amended Review

by Nancy Heidrich January 22, 2021 The Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide Version 2.6 published on July 10, 2017 introduced the CMS Amended Review as another re-review option. The Amended Review allows the parties a one-time request for re-review in the form of a new submission. To be accepted for the amended […]

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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 […]

Is your conditional payment negotiation game up to speed?

There are two entities initiating the recovery of conditional payments for Medicare Part A and B: Benefits Coordination Recovery Center (BCRC) and Commercial Repayment Center (CRC).  CRC collects based upon Ongoing Responsibility for Medical (ORM) reporting entered through the claims system from a carrier/self-insured (or their TPA). In denied cases where ORM is not reported […]

NuQuest Appoints Barbara Fairchild to Role of Chief Executive Officer

NuQuest, the leading provider of Medicare Secondary Payer (MSP) compliance solutions, including Medicare Set-Aside Allocation (MSA), Medical Cost Projection, and Professional Administration services, is pleased to announce the confirmation of Barbara Fairchild as Chief Executive Officer. Under Ms. Fairchild’s leadership, we look forward to a vibrant and flourishing future for our organization and for the […]