Earlier this month the Centers for Medicare and Medicaid Services (CMS) released updated policy guidance surrounding the calculation of Total Payment Obligation to Claimant (TPOC) amounts, required to be reported by Responsible Reporting Entities (RREs) via Section 111, Mandatory Insurer Reporting. A TPOC is defined as a settlement, judgment, award or other payment that is […] Continue
An Amended Review success for our client: Their initial CMS-approved MSA included lumbar surgery and a spinal cord stimulator, both of which we had allocated based on the records reviewed. Per the additional records for the Amended Review, the claimant subsequently underwent lumbar fusion, with significant improvement such that the treating physician ultimately concluded that […] Continue
On October 5, 2020, the Centers for Medicare & Medicaid Services (CMS) released a revised Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide. The updated Guide is version 3.2. As with other versions, a summary of updates to the Guide is found in Section 1.1, and consists of the following changes: The major medical centers […] Continue
Last week representatives from the Commercial Repayment Center (CRC) and Centers for Medicare and Medicaid Services (CMS) Medicare Secondary Payer (MSP) Operations teams hosted a webinar on best practices for conditional payment redetermination requests for Non-Group Health Plan (NGHP) payers. The presentation included a review of the five levels of the Medicare appeals process, the […] Continue
Following up on our July 15, 2020 Blog, The Centers for Medicare & Medicaid Services (CMS) has released to the public the August 13, 2020 Section 111 NGHP Reporting webinar and Questions and Answers document. The presentation highlighted Section 111 reporting tips, best practices, and reminders, as well as Medicare Secondary Payer Recovery Portal (MSPRP) […] Continue