Tag Archives: CMS

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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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 News to Note

November was a busy month for CMS with the issuance of a new NGHP User Guide, Version 6.1 and multiple alerts.  Below is a brief summary of these updates.  2021 Recovery Threshold Alert On November 25, 2020, CMS issued a new alert on the 2021 Recovery Thresholds beginning on January 1, 2021.  The alert notes […]

CMS Issues Section 111 NGHP User Guide Version 6.0

The new Section 111 NGHP User Guide 6.0 (Guide) was issued by CMS on October 5, 2020 and contains several updates as noted below. Chapter III, Section 4.6 of the Guide, CMS has specified what items should be included when calculating the Total Payment Obligation to Claimant (TPOC).  CMS notes that the “TPOC amount includes, […]

New WCMSA Reference Guide 3.2 Issued by CMS

On October 5, 2020, CMS issued a new WCMSA Reference Guide (Guide) version 3.2.  Changes to the Guide include defining what major medical centers the Workers’ Compensation Review Contractors (WCRC) utilize for pricing surgical interventions in WCMSAs.  A copy of the new Guide can be found here. Specifically, CMS added a new Appendix 7 to […]

CMS Provides Webinar: Section 111 Non-Group Health Plan (NGHP)

August 17, 2020 by Patrick Czuprynski  On 8/13/2020, CMS provided a webinar and PowerPoint presentation to highlight and refresh stakeholders regarding certain aspects of Section 111 reporting and the recommendations outlined in the MMSEA Section 111 User Guide. It is important to understand that CMS is using the carrier/self-insured (or their TPA) claims system reporting […]

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 […]

Confusion, Conjecture and Clarification: The New WCMSA Reference Guide

With the issuance of updated Workers’ Compensation Medicare Set-Aside Reference Guide version 2.9 (Guide), there has some speculation and even confusion as to what is really new and what is an elaboration of old policies and procedures.  Examples listed for off-label drug usage to new bullets added regarding the submission process, all of which begs […]