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 »

Ask Annie: MSAs and the “You Break It, You Buy It” Policy

Question: We are trying to settle a workers’ compensation claim with a Medicare beneficiary for $50,000. The claimant sustained an admitted right shoulder injury. He has unrelated neck issues from an old car accident. He and his treater are trying to argue the shoulder injury exacerbated his preexisting neck condition. We have denied the neck… Read more »

CMS Announces Section 111 Technical Updates

On Thursday, January 21, 2021 the Centers for Medicare & Medicaid Services (CMS) released an updated Section 111 NGHP User Guide (back-dated to January 11, 2021).  While it contained nothing earth-shattering, there are a few important updates of note. CMS will now accept a claim with an ORM Termination Date that is up to 75… 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 »

Sertraline (Zoloft®) Price Cut

With the start of a new year, we typically see price hikes but that is not the case with sertraline (Zoloft®) where we have seen a significant price cut. Sertraline, a selective serotonin reuptake inhibitor (SSRI), is FDA approved for major depressive disorder (MDD), obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder (PTSD), premenstrual dysphoric disorder… Read more »

PAID Act Becomes Law

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