NGHP User Guide Version 4.5 Released with New Policy Language Concerning Exposure, Ingestion, and Implantation Claims and December 5, 1980

CMS, Medicare Set-Aside Blog on February 3, 2015
Posted by Jessica M. Wingenroth, JD

The newest version of the NGHP User Guide was released on February 2, 2015, and contains new policy language in Chapter III: Policy Guidance. Section 6.5.1, entitled What Claims Are Reportable? When Are Such Claims Reportable?, addresses the fact that RREs are not required to report liability or no-fault insurance settlements, judgments, awards or other payments when the CMS date of incident is prior to December 5, 1980. New policy language now offers guidance surrounding reporting when there is an amended complaint or supplemental pleading. Specifically:

• Any operative amended complaint (or comparable supplemental pleading) must occur prior to the date of settlement, judgment, award, or other payment and must not have the effect of improperly shifting the burden to Medicare by amending the prior complaint(s) to remove any claim for medical damages, care, items and/or services, etc.

• Where a complaint is amended by Court Order and that Order limits Medicare’s recovery claim based on the criteria contained in this alert, CMS will defer to the Order. CMS will not defer to Orders that contradict governing MSP policy, law, or regulation.

This was the only change from Version 4.4 of the NGHP User Guide. The newest, Version 4.5 of the User Guide can be found here.