The Medicare Medicaid SCHIP Extension Act of 2007 (MMSEA) imposed Mandatory Insurer Reporting obligations on all Responsible Reporting Entities (RREs). These mandatory requirements impart obligations on RREs, and require these entities to provide the Centers for Medicare and Medicaid Services (CMS) with data on claims that involve Medicare beneficiaries. Furthermore, pursuant to the Strengthening Medicare […] Continue
The Strengthening Medicare and Repaying Taxpayers Act of 2012 (the SMART Act) requires the Centers for Medicare & Medicaid Services (CMS) to publish an annual threshold for recovery in November, each year. This threshold amount reflects an amount for which CMS will not spend more on collections than a claim is likely to yield. In […] Continue
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
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 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
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
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
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 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
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