The Medicare Medicaid SCHIP Extension Act of 2007 (MMSEA) imposed Mandatory Insurer Reporting obligations on all Responsible Reporting Entities (RREs) when enacted in 2009. These mandatory requirements specifically imparted obligations on all RREs and required entities to provide the Centers for Medicare & Medicaid Services (CMS) with data on claims that involve Medicare beneficiaries. Furthermore, […] Continue
Yesterday, CMS issued a decision to cover acupuncture for Medicare patients with chronic low back pain (cLBP) to some extent. You may recall that CMS previously issued a proposed decision to cover acupuncture, as we discussed here on our blog. CMS’ final coverage decision memo can be found here, and indicates that acupuncture for chronic […] Continue
Yesterday, the U.S. Department of Justice’s Attorney’s Office for the Eastern District of Pennsylvania issued a press release stating that another Philadelphia-based personal injury law firm, has entered into a settlement agreement with the United States to resolve allegations that it failed to reimburse Medicare Conditional Payments. You may recall we saw a similar action […] Continue
The Centers for Medicare & Medicaid Services issued an alert today that it will be hosting two town hall meetings to discuss common Commercial Repayment Center (CRC) Non-Group Health Plan (NGHP) Ongoing Responsibility for Medicals (ORM) and Group Health Plan (GHP) recovery topics. The first town hall will be held on January 14, 2020 at 1:00 […] Continue
The Medicare Secondary Payer (MSP) provisions of the Social Security Act prohibit Medicare from making payment where payment has been made or can reasonably be expected to be made by a primary plan. If payment has not been made, or cannot reasonably be expected to be made promptly by the plan, Medicare may pay for […] Continue