The Official Medicare Set Aside Blog And Information Resource

CMS Webinar Regarding Changes to the Non-Group Health Plan Recovery Workload

Medicare Set-Aside Blog, News and Events on August 25, 2015 | Posted by Erin O'Neill, PA-C, JD & Renee Martinez

On August 25, 2015, CMS held a webinar outlining the changes in workload processes and procedures in preparation for certain Non-Group Health Plan (NGHP) recovery activity to transition from the Benefits Coordination & Recovery Center (BCRC) to the Commercial Repayment Center (CRC). Effective October 5, 2015, the CRC will assume the responsibility for conditional payment […] Continue

More on the Delaware Collateral Source Rule

Commentary, Medicare Advantage, Medicare Set-Aside Blog, MSP Litigation on August 20, 2015 | Posted by Jennifer Jordan, JD, MSCC

On August 14, 2015, the Superior Court of Delaware used the Stayton decision to rule that future medical damages for Medicare beneficiaries should also be limited by the “amount of projected Medicare write-off.” In this suit following a slip and fall in a retail store, Plaintiff had sought damages for future medical expenses to which […] Continue

CMS: Medicare Residual Payments for WCMSA Depletion & ORM Termination

CMS, Conditional Payments, Medicare Set-Aside Blog, Medicare Set-Asides on August 13, 2015 | Posted by Erin O'Neill, PA-C, JD & Renee Martinez

On August 6, 2015, the Centers for Medicare and Medicaid Services (CMS) issued instructions for the Shared Systems and Medicare Administrative Contractors (MACs) to follow when a Medicare Residual Payment must be paid on Workers’ Compensation Medicare Set-Aside Arrangements (WCMSA) or for Ongoing Responsibility of Medicals (ORM) Non-Group Health Plan (NGHP) Medicare Secondary Payer (MSP) […] Continue

CMS Webinar Regarding Changes to the Non-Group Health Plan Recovery Process and Workload Scheduled for August 25, 2015

CMS, Conditional Payments, Mandatory Insurer Reporting, Medicare, Medicare Set-Aside Blog on August 4, 2015 | Posted by Erin O'Neill, PA-C, JD & Renee Martinez

CMS has announced that a webinar regarding the upcoming changes to the Non-Group Health Plan (NGHP) Recovery Process and Workload will be presented on August 25, 2015 at 2:00 pm EST. As noted in prior posts, effective October 2015, the Commercial Repayment Center (CRC) will assume the responsibility for conditional payment recovery activities in all […] Continue

Collateral Source Rule in Delaware – Part II

Commentary, Medicare Advantage, Medicare Set-Aside Blog, MSP Litigation on August 3, 2015 | Posted by Jennifer Jordan, JD, MSCC

In follow up to the Delaware Supreme Court ruling in Stayton v. Delaware Health Corp. [see blog dated June 22, 2015], declaring Medicare payments not subject to the collateral source rule, the Superior Court on July 28, 2015 extended the application to Medicare Advantage Plans as well. In Honey v. Bayhealth Medical Center, plaintiff attempted […] Continue

CMS’ Fraud Prevention System Creates Significant Impact

Fraud, Medicare, Medicare Set-Asides on July 29, 2015 | Posted by Jennifer Alvarez

The Centers for Medicare & Medicaid Services (CMS) recently recognized and applauded the agency’s internal Fraud Prevention System for the identification or prevention of $820 million in improper payments during the program’s first three years of operation. The focus of the Fraud Prevention System is to help protect Medicare Trust Funds and prevent fraudulent payments […] Continue

Social Security and Medicare Boards of Trustees Call for Swift Action by Lawmakers in 2015

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

Last week the Social Security and Medicare Boards of Trustees released their 2015 Annual Reports, recommending “prompt corrective action by lawmakers.” In their Message to the Public, the most urgent action was called for the Social Security Disability Insurance program, which has trust fund reserves that are expected to deplete in late 2016. A 2016 […] Continue

Avinza Extended-Release Capsules No Longer Being Manufactured

Medicare, Medicare Set-Asides, Rx/Pharmacy on July 22, 2015 | Posted by Erin O'Neill, PA-C, JD & Renee Martinez

The Food and Drug Administration (FDA) has announced that all strengths of Avinza (morphine sulfate) extended release capsules have been discontinued. Avinza is a Schedule II long acting opioid medication indicated for the treatment of severe pain only. Avinza carried a black box warning indicating that misuse could lead to death due to the lack […] Continue

Town Hall Teleconference for NGHP Section 111 Mandatory Insurer Reporting Scheduled for July 28, 2015

CMS, Mandatory Insurer Reporting, News and Events on July 15, 2015 | Posted by Jessica M. Wingenroth, JD

A Town Hall Conference call for policy and technical questions has been scheduled for Tuesday, 07/28/15, from 1:00 PM to 2:00 PM EST. Full details can be found here: http://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Mandatory-Insurer-Reporting-For-Non-Group-Health-Plans/Downloads/New-Downloads/NGHP-Town-Hall-Teleconference-Notice-July-28-2015.pdf Continue

NGHP MMSEA Section 111 User Guide Version 4.7 Released

CMS, Mandatory Insurer Reporting, MSP News on July 14, 2015 | Posted by Jessica M. Wingenroth, JD

In their fourth update this year, CMS applied four change requests to Version 4.7 of the NGHP MMSEA Section 111 User Guide. All changes incorporated information published in prior Alerts. Within Version 4.7 you can find the new: Recovery Agent process with dedicated fields, eliminating the prior TPA workaround; Section 111 Coordination of Benefits Secure […] Continue