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 […]
CMS has issued a Commercial Repayment Center Non-Group Health Plan Applicable Plan Appeal Guide (Appeal Guide) in the Download section on the Insurer NGHP Recovery page on CMS.gov. A copy of the Appeal Guide can be found here. The Appeal Guide outlines the steps in the appeals process; appeal requirements; necessary authorizations; what is and […]
The new Section 111 NGHP User Guide 6.0 (Guide) was issued by CMS on October 5, 2020 and contains several updates as noted below. Chapter III, Section 4.6 of the Guide, CMS has specified what items should be included when calculating the Total Payment Obligation to Claimant (TPOC). CMS notes that the “TPOC amount includes, […]
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