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 […]
On November 17, 2016, Medicare states the following during a townhall presentation, click here for link to transcript. As many of you may be aware the CRC systematically filters all claims before issuing CPLs, CPNs and Demand letters so that the conditional payments specifically sought for recovery are related to the No-Fault insurance or Workers’ […]
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 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 […]
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 […]
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 […]
Pursuant to Section 184.108.40.206 of the WCMSA Reference Guide, version 2.8, prescription medication pricing is based upon the Average Wholesale Price (AWP) of the drug with generic drugs being priced at the lowest non-repacked AWP rate. In accordance with WCMSA pricing guidelines, NuQuest submitted a WCMSA utilizing the lowest AWP price for a prescribed generic […]
CMS seeks comment from industry professionals on options being considered for beneficiaries and their representatives to clarify how they can meet their obligations to protect Medicare’s interest in MSP Workers’ Comp or Liability claims. Comments must be submitted to CMS no later than 5 p.m. on August 14. Click here for more information.
NuQuest/Bridge Pointe (NQBP) and myMatrixx have teamed up to maximize MSA savings potential and minimize the risk of prolonged settlement negotiations! This comprehensive solution identifies and optimizes opportunities to lower costs associated with both medical treatment and pharmacy utilization. The Pre-MSA with Drug Regimen Review (PMDR) combines a medical analysis and Drug Regimen Review to […]
On April 3, 2012, Government Accountability Office (GAO) released a report – “Medicare Secondary Payer – Additional Steps are Needed to Improve Program Effectiveness for Non-Group Health Plans” – reflecting challenges, workloads, average MSA amounts approved, and more. The full report is available here.