The Official Medicare Set Aside Blog And Information Resource

Changes to the Non-Group Health Plan Recovery Workload

CMS, Conditional Payments, ICD-10, Mandatory Insurer Reporting, Medicare Set-Aside Blog, News and Events on July 1, 2015 | Posted by Erin O'Neill, PA-C, JD

Following the 2013 transition of most Group Health Plan (GHP) recovery activity to the Commercial Repayment Center (CRC), CMS has announced that certain Non-Group Health Plan (NGHP) recovery activity will also be transitioned to the CRC in the near future. Effective October 2015, the CRC will assume the responsibility for conditional payment recovery activities in […] Continue

Is Medicare Advantage Entitled To Bring A Private Cause Of Action Under The Medicare Secondary Payer Act?

CMS, Medicare, Medicare Advantage, Medicare Set-Aside Blog, MSP Litigation on June 24, 2015 | Posted by Kimberly Wiswell

This law review by Jennifer Jordan, general counsel at MEDVAL, was recently published in the William Mitchell Law Review. It’s an in-depth analysis of the current state of Medicare Advantage recovery rights and provides a well-reasoned rationale as to whether or not MAOs were intended to share exactly the same recovery rights as traditional Medicare. Due […] Continue

Medicare Reimbursement and Collateral Source Rule in Delaware

Commentary, Medicare Set-Aside Blog, MSP Litigation on June 22, 2015 | Posted by Jennifer Jordan, JD, MSCC

On June 12, 2015, the Supreme Court of Delaware rendered a decision in Stayton v. Delaware Health Corporation, et al. opining that the collateral source rule would not apply in the recovery sought by the plaintiff. The case involves a 76 year old wheelchair bound resident of the Harbor Healthcare and Rehabilitation Center. Plaintiff is […] Continue

Technical Alert: CMS Sets a New Standard for Partial SSN Queries

CMS, Medicare Set-Aside Blog on June 19, 2015 | Posted by Jessica M. Wingenroth, JD

CMS has changed the criteria for matching Medicare beneficiaries on an NGHP Mandatory Insurer Reporting Query, but only if a partial SSN has been entered. Effective immediately, when a partial SSN is submitted for query, all five data elements must produce an exact match to a Medicare beneficiary for a result to be returned. Alternatively, […] Continue

CMS Quietly Proposing Adjustments to Future Medicaid Recovery Processes

CMS, Medicaid, Medicare Set-Aside Blog, News and Events, Work Comp on June 4, 2015 | Posted by Erin O'Neill, PA-C, JD

As noted in our previous post entitled “Medicaid Recoveries and Workers’ Compensation” it appears that Medicaid recovery efforts in workers’ compensation claims have begun in certain states. While it was uncommon in the past for worker’s compensation claimants to also be entitled to Medicaid, with the Medicaid expansion provided by the Affordable Care Act, greater […] Continue

Medicaid Recoveries and Workers’ Compensation

Medicaid, Medicare Set-Aside Blog, News and Events, Work Comp on June 3, 2015 | Posted by Jennifer Jordan, JD, MSCC

Let the games begin. It was recently reported to me that TPAs throughout the State of Kentucky were blanketed with “we understand that you may be responsible” letters for a number of state Medicaid recipients also on workers’ compensation. Don’t panic but we are about to embark on a whole new world of government bureaucracy […] Continue

Multi-Factor Authentication (MFA) coming soon on the Medicare Secondary Payer Portal (MSPRP)

CMS, Medicare Set-Aside Blog, MSP News on May 29, 2015 | Posted by Renee Martinez

The Centers for Medicare & Medicaid Services (CMS) will be implementing optional Multi-factor Authentication (MFA) services on the Medicare Secondary Payer Portal (MSPRP). This change is being made as part of the work related to implementation of the Strengthening Medicare and Repaying Taxpayers (SMART) Act. MFA involves the use of two or more different authentication […] Continue

Establishing Appeal Rights for Applicable Plans – Presentation Now Available

CMS, Medicare Set-Aside Blog, MSP News on May 28, 2015 | Posted by Erin O'Neill, PA-C, JD

CMS has posted the slides from the May 5, 2015 webinar regarding the Appeals Rights for Applicable Plans. The presentation, entitled “Applicable Plan” Appeals: Appealing a Medicare Secondary Payer Recovery Claim where Medicare pursues recovery from insurers or workers’ compensation entities, is located in the Downloads Section of the Insurer Services What’s New page on […] Continue

New Section 111 COBSW URL Coming June 14, 2015

CMS, Medicare Set-Aside Blog on May 27, 2015 | Posted by Jessica M. Wingenroth, JD

On June 14, 2015, users of the Section 111 Coordination of Benefits Secure Website (COBSW) will be redirected to a new URL: https://www.cob.cms.hhs.gov/Section111/. Redirection will occur for 90 days, during which time users should transition to the new URL. CMS’ full technical alert is published under Downloads, via this link: http://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Mandatory-Insurer-Reporting-For-Non-Group-Health-Plans/NGHP-Alerts/NGHP-Alerts.html Continue

MSP vs PIP – Part 2

Commentary, Medicare Set-Aside Blog, MSP Litigation on May 21, 2015 | Posted by Jennifer Jordan, JD, MSCC

In April we saw our first MSP case involving a PIP carrier denying reimbursement responsibilities for medical benefits related to a covered auto accident that were paid by Medicare. [MSP RECOVERY, LLC v. PROGRESSIVE SELECT INSURANCE CO., 2015 U.S. Dist. LEXIS 47784 (Apr. 1, 2015)]. In that case, court found that plaintiff did “not allege […] Continue