Tag Archives: Conditional Payments

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 […]

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 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 […]

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 […]

MSPRC Announces Electronic Submission Portal

The Medicare Secondary Payer Recovery Contractor (MSPRC) has announced plans to implement a web-based electronic submission portal. The MSPRC is launching a pilot program to test their new portal in the upcoming months with a projected “go live” date in July, 2012. This portal will facilitate and expedite the conditional payment process for Liability Insurance, […]

“Self-Calculated Final Conditional Payment Amount” Option

The Centers for Medicare & Medicaid Services (CMS) will be implementing an option that will allow certain Medicare beneficiaries to obtain Medicare’s final conditional payment amount prior to settlement. This option will be available in February 2012, for certain settlements involving physical trauma based injuries where treatment has been completed. Under this option, the beneficiary […]

The SMART Act Is Introduced in the United States Senate

On October 17, 2011, the Strengthening Medicare and Repaying Taxpayers Act of 2011 (SMART Act) was introduced in the United States Senate by Senators Ron Wyden (D-OR) and Rob Portman (R-OH). The Senate bill number is S. 1718. The SMART Act was previously introduced in the United States House of Representatives in March 2011 by […]

Stanton v. State Farm Mutual Insurance

Stanton v. State Farm Mutual Insurance Automobile Insurance Company No. 11-cv-282-JPG-DGW 2011 WL 3678912 (S.D.Ill.Aug. 22, 2011)  This case involved an attempt by a defendant insurer (State Farm) to include Medicare’s recovery contractor (MSPRC) on the settlement check in relation to the resolution of a wrongful death claim to ensure that Medicare’s interests were properly […]

Benson v. Sebelius

Benson v. Sebelius Civil Action No. 09-1931 (RMU), 2011 WL 1087254 (D. D.C. March 24, 2011) This case involved a wrongful death and survival action. The parties settled the claim for $90,000, with 80% of that amount allocated for the wrongful death settlement award and 20% allocated for the survival claim. Medicare issued a final […]