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 »

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.

Maintaining Status Quo: CMS Retains $750 TPOC and Recovery Threshold

True to form, the Centers for Medicare & Medicaid Services (CMS) released another Alert during a holiday weekend.  This time, on the day before Thanksgiving Day, CMS announced that the Total Payment Obligation to the Claimant (TPOC) and Conditional Payment recovery thresholds for Workers’ Compensation, Liability, and No-Fault insurance claims remain unchanged at $750.  These… Read more »

CMS Announces Section 111 Technical Updates

On Thursday November 12th the Centers for Medicare & Medicaid Services (CMS) released an alert and an updated Section 111 NGHP User Guide to improve data quality efficiencies for Section 111 reporting services.  The updates will convert some data validation errors into “soft edits,” allowing the claims record to be processed despite minor data quality… Read more »