Tag Archive: Conditional Payments
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CMS Launches New NGHP Civil Money Penalties Webpage
by B. Smith The Centers for Medicare and Medicaid Services (CMS) has launched a new webpage regarding Section 111 Civil Money Penalties (CMPs) for Non-Group Health Plans (NGHP). The webpage...
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Understanding Medicare’s Three-Year Dates of Service Limitation
by P. Czuprynski The Medicare Secondary Payer Act requires reimbursement from an insurer or self-insured entity associated with a workers’ compensation, or a liability claim when there is (1) reasonable...
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Medicare Advantage Plans: Navigating Conditional Payment Appeals
by P. Czuprynski Federal regulations require Medicare Advantage Plans (MAPs) establish an administrative appeal process that allows a Qualified Independent Contractor, an Administrative Law Judge, the Medicare Appeals Council, and...
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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),...