The Official Medicare Set Aside Blog And Information Resource

CMS Releases Updated NGHP User Guide

CMS, Mandatory Insurer Reporting, Medicare Set-Aside Blog, MSP News on January 9, 2017 | Posted by Jean S. Goldstein, JD

CMS updated their Non-Group Health Plan (NGHP) User Guide, and released version 5.2.  The updated guide can be found here. The only update to the guide is the change in thresholds for reporting certain cases with total payment obligation to the claimant (TPOC), as indicated in CMS’ recently issued alerts and as previously discussed here […] Continue

How Will Mandatory Reporting Be Affected by CMS’ Announcements Regarding Thresholds?

CMS, Mandatory Insurer Reporting, Medicare Set-Aside Blog, MSP News on December 13, 2016 | Posted by Jean S. Goldstein, JD

CMS recently announced a change in the reporting thresholds to $750 for liability settlements, and advised that it would maintain the $750 threshold for no-fault and workers’ compensation settlements, where the insurer or entity does not otherwise have ongoing responsibility for medicals (ORM).  Just yesterday, CMS issued a technical alert regarding the change in reporting […] Continue

Updates to NGHP MMSEA Section 111 User Guide Version 5.1 Released

CMS, Mandatory Insurer Reporting, MSP News on October 13, 2016 | Posted by Jean S. Goldstein, JD

Updates to the NGHP User Guide have been released. The updates are minor, and reflect only the references which are available under the Reference Materials menu found on the Coordination of Benefits Secure Website (COBSW). The updates of the chapters of the user guide are: Chapter I- Introduction and Overview and Chapter 2- Registration Procedures: […] 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

NGHP Mandatory Insurer Reporting Reminder: Report Recovery Agent Information in Designated Fields

CMS, Mandatory Insurer Reporting, Medicare Set-Aside Blog on March 3, 2016 | Posted by Jessica M. Wingenroth, JD

CMS is reminding RREs to use the designated Recovery Agent reporting fields that were implemented on 07/13/15, and not the TIN Reference File fields previously employed as a workaround. If the Third Party Administration (TPA) workaround was utilized in the past, RREs are required to resubmit all TIN Reference File records that are corrected to […] 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

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