The Official Medicare Set Aside Blog And Information Resource

Proposed Civil Money Penalties Rule for Medicare Reporting to be Released

Mandatory Insurer Reporting, Medicare Set-Aside Blog, MSP News on February 14, 2020
Posted by Jean S. Goldstein, JD, CMSP

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

Acupuncture Is Coming Soon to an MSA Near You: CMS Issues Decision to Cover Acupuncture for Medicare Beneficiaries

CMS, Medicare, Medicare Set-Aside Blog, MSP News, Opioids on January 22, 2020
Posted by Jean S. Goldstein, JD, CMSP

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

Warning: Another Law Firm Reprimanded for Failing to Repay Medicare Conditional Payments

Compliance, Conditional Payments, Medicare Set-Aside Blog, MSP News on January 9, 2020
Posted by Jean S. Goldstein, JD, CMSP

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

CMS to Host Town Hall Meetings to Discuss Medicare Secondary Payer Recovery Topics

CMS, Conditional Payments, Medicare Set-Aside Blog, MSP News on December 5, 2019
Posted by Jean S. Goldstein, JD, CMSP

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

CMS Will Maintain $750 Recovery Threshold for 2020

Mandatory Insurer Reporting, Medicare Set-Aside Blog, MSP News on November 27, 2019
Posted by Jean S. Goldstein, JD, CMSP

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