Tag Archive: Section 111 Reporting
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CMS Issues Frequently Asked Questions Document for Civil Money Penalties
by B. Smith In a follow-up to the release of the final rule for Civil Money Penalties (CMPs), the Centers for Medicare and Medicaid Services (CMS) issued an alert regarding...
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CMS Releases NGHP Appeals Reference Guide 1.0
by B. Smith The Centers for Medicare & Medicaid Services (CMS) recently released the first Non-Group Health Plan (NGHP) Applicable Plan Appeals Reference Guide, Version 1.0 (Guide) dated April 27,...
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Medicare Advantage Plans: PAID ACT – Year One
by P. Czuprynski Carriers and self-insureds, or their vendors, have the ability to ask Medicare if a particular claimant is enrolled in Medicare benefits through either an electronic data request or...
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Key Takeaways from CMS’ NGHP Reporting Webinar
by F. Fairchok CMS hosted a webinar on December 6, 2022, to discuss best practices for Section 111 Reporting for Non-Group Health Plan (NGHP) entities. The one-hour webinar began with...
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CMS Issues New WCMSA Reference Guide Version 3.8
By B. Smith Yesterday, CMS released version 3.8 of their Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide, which now includes an additional Re-Review option when the parties wish to...
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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...