The Official Medicare Set Aside Blog And Information Resource

CIGA Wins Partial Summary Judgment on Issue of Over-inclusive Reimbursements

Conditional Payments, Jen Article, Medicare Set-Aside Blog, MSP Litigation on January 9, 2017 | Posted by Jennifer Jordan, JD, MSCC

On January 5, 2017, the U.S. District Court for the Central District of California ruled in favor of the California Insurance Guarantee Association (CIGA) in its ongoing challenges against CMS over its MSP practices. After several years and many amended complaints, the only remaining issue in this litigation was CIGA’s allegations that CMS calculates its […] Continue

Teleconference Call Recap: CMS and CRC Address Delays and Enhancements  

CMS, Conditional Payments, CRC, Medicare Set-Aside Blog, MSP News on November 21, 2016 | Posted by Jean S. Goldstein, JD

On Thursday, November 17, the Centers of Medicare and Medicaid Services’ (CMS) held a teleconference, with both CMS representatives and Commercial Repayment Center (CRC) representatives available to provide long awaited explanations.  The call served as a general update for cases processed through the CRC, as a means to issue reminders to stakeholders, and to allow […] Continue

CMS Issues Alert Regarding Conditional Payment Recovery Thresholds

CMS, Conditional Payments, Mandatory Insurer Reporting, Medicare Set-Aside Blog on September 29, 2016 | Posted by Jean S. Goldstein, JD

Yesterday, CMS issued an alert implementing a $750 threshold for no-fault insurance and workers’ compensation entities that do not otherwise have an ongoing responsibility for medicals.  This new thresholds means that CMS will not seek recovery of conditional payments made on workers’ comp or no-fault claims falling under the $750 threshold, as long as there […] Continue

Final Rule Regarding Expansion of the Functionality of the Medicare Secondary Payer Recovery Portal

CMS, Conditional Payments, MSP News on May 19, 2016 | Posted by Erin O'Neill, PA-C, JD

On May 17, 2016, The Centers for Medicare and Medicaid Services (CMS) released the final rule, specifying the timeline and process for expansion of the current Medicare Secondary Payer Recovery Portal. The Final Rule, entitled Medicare Program; Obtaining Final Medicare Secondary Conditional Payment Amounts via Web Portal was published in the Federal Register and can […] Continue

Enhanced Functionality and Other Changes to the Medicare Secondary Payer Recovery Portal as of January 1, 2016

CMS, Conditional Payments, Mandatory Insurer Reporting, Medicare, Medicare Set-Aside Blog, MSP News on January 6, 2016 | Posted by Erin O'Neill, PA-C, JD

As of January 1, 2016, the Medicare Secondary Payer Recovery Portal (MSPRP) now includes functionality for obtaining a final conditional payment amount on those cases that are 120 days or less from an anticipated settlement. These changes were implemented as part of the Strengthening Medicare and Repaying Taxpayers Act of 2013. Authorized users are now […] Continue

CMS Issues Reminder Regarding Accurate Reporting of ICD-9 and ICD-10 codes for Ongoing Responsibility for Medicals (ORM)

CMS, Conditional Payments, Mandatory Insurer Reporting, Medicare, Medicare Set-Aside Blog on December 29, 2015 | Posted by Erin O'Neill, PA-C, JD

CMS has indicated that effective January 1, 2016, claims processing contractors will begin to utilize information provided by workers’ compensation entities/insurers for the purpose of reporting Ongoing Responsibility for Medicals (ORM), to determine whether Medicare is able to make primary payment for those claims. As they have done in the past, CMS emphasizes the importance […] Continue

Personal Injury Attorney Suspended for Poor Handling of Medicare Conditional Payment Reimbursement

Conditional Payments, Medicare, Medicare Set-Aside Blog, MSP Litigation on December 7, 2015 | Posted by Jennifer Jordan, JD, MSCC

Anyone can resolve a Medicare reimbursement. You don’t need to be a lawyer or MSP specialist. But the reason companies like ours exist is because CMS doesn’t make it easy. If you do not know how to navigate the process, it could take a long time. You may contact the wrong contractor and not receive […] Continue

Upcoming Enhancement to the Functionality of the Medicare Secondary Payer Recovery Portal

CMS, Conditional Payments, Mandatory Insurer Reporting, Medicare, Medicare Set-Aside Blog on November 13, 2015 | Posted by Erin O'Neill, PA-C, JD

The Centers for Medicare and Medicaid Services (CMS) has announced that the Medicare Secondary Payer Recovery Portal (MSPRP) will be updated to include functionality for obtaining a final conditional payment amount on those cases that are 120 days or less from an anticipated settlement. As part of the Strengthening Medicare and Repaying Taxpayers Act of […] Continue

CMS Releases FAQ Document Regarding the Commercial Repayment Center Non-Group Health Plan Recovery Workload Transition

CMS, Conditional Payments, Mandatory Insurer Reporting, Medicare, Medicare Set-Aside Blog on October 27, 2015 | Posted by Erin O'Neill, PA-C, JD

On October 26, 2015, the Centers for Medicare and Medicaid Services (CMS) released a Frequently Asked Questions (FAQ) Document in order to provide information regarding the transition of a portion of the Non-Group Health Plant (NGHP)Medicare Secondary Payer (MSP) recovery workload from the Benefits Coordination & Recovery Center (BCRC) to the Commercial Repayment Center (CRC). […] Continue

Recovery Agent Authorization Model Language

CMS, Conditional Payments, Mandatory Insurer Reporting, Medicare, Medicare Set-Aside Blog on October 18, 2015 | Posted by Erin O'Neill, PA-C, JD

CMS has released model language identifying those elements that must be included in an authorization request for a Recovery Agent representing an Applicable Plan in Medicare Secondary Payer recovery claim activities. All authorization request documents must include the following elements: A statement that the Applicable Plan appoints the Recovery Agent to act on its behalf. […] Continue