On September 9, 2021, CMS hosted another webinar to discuss upcoming changes to the Section 111 query process. These changes are being made to comply with the provisions of the PAID Act which requires CMS to provide enrollment information for Medicare Part C and Part D plans. The following are some of the key highlights […]
On September 9, 2021, CMS will be hosting a Provide Accurate Information Directly (PAID) Act testing webinar. Webinar details can be found here. Should you have any questions regarding the PAID Act and the impact it will have on the Section 111 query process, please contact the NuQuest Settlement Consultants at: [email protected]
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 […]
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 […]
by Nancy Heidrich January 22, 2021 The Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide Version 2.6 published on July 10, 2017 introduced the CMS Amended Review as another re-review option. The Amended Review allows the parties a one-time request for re-review in the form of a new submission. To be accepted for the amended […]
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 […]
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