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’ […]
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 […]
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 […]
Attention Workers’ Comp Insurers – CMS has announced NEW mandatory thresholds applicable to all WC Settlements, Judgments, Awards and other payments. TPOC Implementation timeline and payment thresholds to claimants have been revised for Section 111 reporting. Click here to review the revised TPOC dates and dollar amounts.
Attention Liability Insurers (including Self-Insurers) — TPOC Implementation timelines and payment thresholds to claimants have been revised for Section 111 reporting. The NEW mandatory thresholds apply to all Settlements, Judgments, Awards and other payments and supersede the current User Guide, version 3.3 and the TPOC Alert dated September 30, 2011. Click here to review new […]
CMS has released a new NGHP Policy and Technical Support teleconference schedule. DATES: February 23, 2012 March 22, 2012 April 24, 2012 May 24, 2012 June 19, 2012 The CMS notice is available here.
CMS has issued an MMSEA Section 111 Mandatory Insurer Reporting Quick Reference Guide for non-GHP Insurers. The guide has been developed to provide the following: Explaination of MMSEA Section 111 reporting, and how it may affect you Help in determine if you are an MMSEA Section 111 “Responsible Reporting Entity” (RRE) An overview on how […]
Smith v. Sound Breeze Condo Ass’n of Groton No. KNLCV 095012261s, 2011 WL 803067 (Ct. Sup. Ct., Feb. 3, 2011) In this case, the RRE requested permission to file a set of non-standard interrogatories to obtain the plaintiff’s name, address, social security number, birth date and gender so that it could determine Medicare status for […]
Hackley v. Garofano No. CV 095031940S, 2010 WL 3025597 (Ct. Sup. Ct., July 1, 2010) This case involved a 16 year old plaintiff who was injured in a motor vehicle accident. Since the plaintiff was a minor, his father had to bring the action on his behalf. The parties reached a settlement for $7,500, but […]
Seger v. Tank Connection LLC, 8:08 CV 75, 2010 WL 16652353 (D. NE., April 22, 2010) In this case, the Responsible Reporting Entity (RRE) requested that the plaintiff produce his social security number and other information so the RRE could use the Section 111 Query Process system to determine Medicare status. However, the plaintiff refused […]