CMS Updates WCMSA Reference Guide: New Policy on EBMSAs

Yesterday, CMS released an updated Workers’ Compensation Medicare Set-Aside (WCMSA) Reference Guide.  Version 3.5 of the guide contains two new sections and no other changes.  The additional sections relate to evidence-based on non-submit Medicare Set-Asides and the pre-requisite steps prior to submitting a workers’ compensation settlement for review. ECS has evaluated the additional sections and… Read more »

Medicare’s Epic Game of “Kick the Can” Continues…

Yet again, Medicare pushed back the unveiling of a notice of proposed rulemaking on regulations governing post-settlement medical care of Medicare beneficiaries. ECS briefed this issue in both July and December 2020 and at that time Medicare planned to release the proposed regulation in March 2021. March came and went without fanfare, and then in June Medicare and the Office of Management… Read more »

CMS Updates Section 111 NGHP User Guide

On Tuesday October 5th the Centers for Medicare & Medicaid Services (CMS) published version 6.5 of the NGHP User Guide. There are a number of substantive changes, although nothing earth-shattering.  As with prior key updates, ExamWorks Compliance Solutions is here to give you all the important details on what has changed in this version. Here… Read more »

Minor Change at CMS Should Result in Quicker Claim Acceptance

On Monday, September 27, 2021, the Centers for Medicare and Medicaid Services (CMS) announced a minor, yet impactful change to their Section 111 processes.  October 4, 2021, CMS will accept a claim when the MSP effective date is up to three months in the future.  In turn, the CMS system will create an MSP record… Read more »

A Comprehensive View of the Amended Review Process

Recap of Amended Review: It has been four years since CMS introduced its Amended Review process on July 10, 2017. By way of background, Amended Review finally afforded the parties with an opportunity for a second bite of the apple following the issuance of a CMS decision. Qualifying cases for Amended Review must provide a… Read more »

The PAID Act: Offering Hope to Coordinate Medicare Advantage Claims

On December 11, 2020, the MARC Coalition succeeded in its efforts to have Congress enact the Provide Accurate Information Directly (“PAID”) Act, filling a gaping hole in the MSP claims resolution process related to Medicare Advantage Organizations and Part D Plans (collectively “MAOs”).  The new law, included as section 1301 of H.R. 8900 (116th Congress,… Read more »

CMS Announces Joint NGHP Town Hall with CRC and BCRC

The Centers for Medicare & Medicaid Services (CMS) announced on February 25, 2021 an upcoming joint town hall with both The Benefits Coordination & Recovery Center (BCRC) and The Commercial Repayment Center (CRC).  The town hall will take place on Thursday April 1, 2021 at 1:00 PM EST.  The town hall will focus on questions… Read more »

MSA Risk and Reward: Examining “Non-Threshold” Settlements

Here is a sneak peek into this week’s webinar topic. Register here if you haven’t already. First, what is a “Threshold” Settlement?   Let’s examine the guidance set forth by Medicare in its Workers’ Compensation Medicare Set-Aside Allocation (WCMSA) Reference Guide. Medicare outlines its workload review criteria in Section 8.1 and indicates it will review a… Read more »

PAID Act Becomes Law

This week Medicare updated the announcement to better define the scope of the proposal.