Tag Archives: Medicare

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 […]

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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 […]

Section 111: What is Medicare missing?

Workers’ compensation and liability insurance carriers have the obligation to report two essential events if a claim involves a Medicare Beneficiary: Ongoing Responsibility for Medical (ORM) Settlement, judgment, award, or other payment Medicare refers to a settlement, judgment award, or other payment as “Total Payment Obligation to Claimant (TPOC).” These two events require the carrier/self-insured […]

Medicare Advantage Organization Seeks More than Double Damages

Medicare Advantage Organization Seeks More than Double Damages: Aetna Life Ins. Co. v. Guerrera, 2020 U.S. Dist. Lexis 139949 In Aetna Life Ins. Co. v. Guerrera, the U.S. District Court for Connecticut determined that a liability insurance carrier was responsible for conditional payments associated with a settlement with a Medicare beneficiary. In the circumstances of […]

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 […]

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 […]

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The OMB Issues Intent of Notice of Proposed Rule Making for Section 111 Penalties

In an abstract entitled “Civil Money Penalties and Medicare Secondary Payer Reporting Requirements,” the Office of Management and Budget has issued another intent of Notice of Proposed Rulemaking this time involving Section 111 Reporting penalties.  Specifically, the abstract of the Notice provides as follows: Section 516 of the Medicare Access and CHIP Reauthorization Act of […]