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, […]
August 17, 2020 by Patrick Czuprynski On 8/13/2020, CMS provided a webinar and PowerPoint presentation to highlight and refresh stakeholders regarding certain aspects of Section 111 reporting and the recommendations outlined in the MMSEA Section 111 User Guide. It is important to understand that CMS is using the carrier/self-insured (or their TPA) claims system reporting […]
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 […]
July 6, 2020 by Patrick Czuprynski, JD, MSCC, CMSP On 6/29/2020, Medicare issued an update to its NGHP User Guide. The following is a summary of those updates: Chapter III: Policy Guidance Sections 6.4.2, 6.4.3 and 6.4.4 were updated to remind Responsible Reporting Entities(RRE) that the $750 settlement reporting threshold does not apply to liability […]
Jun 12, 2020 by Bridget Smith, JD CMS Issues New Section 111 Alert for Reporting No-Fault Insurance Limit on Non-Group Health Plan (NGHP) Claim Input Files In this Alert dated June 8, 2020, CMS reminds Non-Group Health Plan (NGHP) Responsible Reporting Entities (RREs) that when reporting No-Fault Insurance Limits via Section 111 both Med Pay […]
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