The Official Medicare Set Aside Blog And Information Resource

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

Implementation of the Multi-factor Authentication on the Medicare Secondary Payer Recovery Portal

CMS, Conditional Payments, Mandatory Insurer Reporting, Medicare, Medicare Set-Aside Blog on September 10, 2015 | Posted by Erin O'Neill, PA-C, JD

The Centers for Medicare & Medicaid Services (CMS) has implemented the optional Remote Identity Proofing (RIDP)/Multi-factor Authentication (MFA) services on the Medicare Secondary Payer Recovery Portal (MSPRP). These services are part of a new identity management solution provided by CMS as part of the Strengthening Medicare and Repaying Taxpayers (SMART) Act. Today, CMS posted a […] Continue

CMS Webinar Regarding Changes to the Non-Group Health Plan ORM Recovery Process and Workload Scheduled for September 17, 2015 at 2:00pm EST

CMS, Conditional Payments, Mandatory Insurer Reporting, Medicare, Medicare Set-Aside Blog on September 3, 2015 | Posted by Erin O'Neill, PA-C, JD

As indicated during the prior CMS webinar presented on August 25, 2015, CMS will be providing another webinar regarding the upcoming changes to the Non-Group Health Plan (NGHP) Recovery Process and Workload on September 17, 2015 at 2:00 EST. As noted in prior posts, effective October 2015, the Commercial Repayment Center (CRC) will assume the […] 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

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

CMS’ Fraud Prevention System Creates Significant Impact

Fraud, Medicare, Medicare Set-Asides on July 29, 2015 | Posted by Jennifer Alvarez, JD, RN, MSCC, CMSP

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