Blog
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CMS Withdraws Future Medicals Proposed Rule
by B. Smith The Office of Management and Budget (OMB) posted a notice on its website yesterday that the Centers for Medicare & Medicaid Services (CMS) has formally withdrawn the...
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CMS Publishes NGHP User Guide Version 6.9
by F. Fairchok CMS published an update to the NGHP User Guide on October 3, 2022. Version 6.9 announced changes to the areas of ICD coding and SP31 error code...
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Eleventh Circuit Finds Medicare Advantage Plans Subject to Four-Year Statute of Limitations for Private Cause of Action Claims
by B. Smith The Eleventh Circuit Court of Appeals dismissed a private cause of action claim brought by MSPA Claims 1 LLC (Plaintiff) against insurer Tower Hill (Defendants) finding that...
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Medicare Issues Group Health Plan (GHP) Defense Reference Guide
by P. Czuprynski Recently, Medicare issued a reference guide associated with conditional payment recovery related to group health plan claims. So, if a person has group health coverage AND Medicare...
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Eleventh Circuit Holds Section 111 Reporting Can Establish Elements of Private Cause of Action Under MSP Act
by B. Smith The Eleventh Circuit Court of Appeals in MSP Recovery Claims, Series LLC v. Metropolitan General Insurance Company, et. al., Case No. 21-11547 (11th Cir. July 18, 2022),...
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CMS Issues WCMSA Reference Guide Version 3.7
Recently, CMS issued Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide Version 3.7. CMS updated Section 10.3 with a new link to the CDC Life Table. IMPAXX shared the news that...
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CMS to Begin Using 2019 Life Table
Starting June 4, 2022, the Centers for Medicare and Medicaid Services (CMS) will begin using the Center for Disease Control’s (CDC) “Table 1: Life Table for the total population:...
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Clearing Up Non-Submit MSAs – CLM Magazine
Co-Chief Executive Officers Barbara Fairchild and Jon Gunter recently wrote an article for CLM Magazine, Clearing Up Non-Submit MSAs, where they provide their insights on Section 4.3 of WCMSA...
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Conditional Payments: Recent Wins
By P. Czuprynski After administrative appeals, IMPAXX recently won two claims associated with conditional payments. In both cases, Adjudicators (ALJ) with the Office of Medicare Hearing and Appeals determined Medicare...