October 8, 2021 Sam Crepeau, Medicare Compliance Counsel, ISG On October 4th, the Centers for Medicare and Medicaid Services (CMS) began accepting Medicare entitlement effective record dates up to three (3) months in the future for Non-Group Health (NGHP) claims. A copy of the notice text can be found here. This minor change to reporting…
September 20, 2021 Stacy Piazza, CMSP – MSP National Account Manager How many times have you been ready to settle your claim and find out you need an MSA? Not only do you need an MSA, but you are missing vital medical records that will be needed to prepare the MSA? Or you need to…
September 8, 2021 Evidence based MSA’s are growing increasingly more popular in Workers’ Compensation settlements involving Medicare beneficiaries as they provide several benefits: Expediting the settlement process – While CMS has made great strides over the past 3-5 years in expediting the CMS review process, it is no longer the timeframe that provides the most hindrance…
By Sam Crepeau – Medicare Compliance Counsel and Katie A. Fox, MSCC, CMSP – SVP Medicare Compliance August 10, 2021 Last month, the Centers for Medicare and Medicaid Services (CMS) hosted a town hall discussing implementation of the PAID Act, slated to go into effect December 11th, 2021. While there is much to be discussed…
By Sam Crepeau, Esq. & Katie A. Fox, MSCC, CMSP June 25, 2021 Wednesday the Centers for Medicare and Medicaid Services (CMS) hosted a town hall event, focusing on implementation of the PAID Act. As a refresher, the PAID Act requires Medicare to include Medicare Advantage plan (Part C) and Prescription Drug plan (Part D)…
By Katie Fox, MSCC, CMSP & Stacy Piazza, CMSP, ISG June 11, 2021 Closely following the release of the technical alert for the PAID Act, CMS has released an Update to the NGHP User Guide, NGHP User Guide Version 6.4, surrounding the criteria for terminating ORM. The most recent version includes updates to Chapters II,…
By Sam Crepeau & Stacy Piazza, ISG June 9, 2021 Today the Centers for Medicare and Medicaid Services (CMS) released a technical alert regarding the implementation of the PAID Act. As a refresher, the PAID Act (Provide Accurate Information Directly Act) was signed into law in December 2020 as a modification to the NGHP Section…
Joanne McCulloch, RN, CCM, MSCC, LNC May 17, 2021 While the long-term effects of Covid-19 are still unknown, one year later, we are looking at the potential need for Medicare Set-Asides (MSAs) in the Worker’s Compensation claims area. Does the condition of Covid-19 qualify as “work related “or “occupational”? That may depend on the type…
Sam Crepeau, Medicare Compliance Counsel, ISG May 12, 2021 Two recent federal court decisions weighed in on how Medicare’s Secondary Payer (MSP) provision applies in different but important contexts. They illustrate MSP law continues the present challenges to insurers, the judiciary, plan administrators and Medicare beneficiaries. While clarity around the interpretation of the law is…
Joanne McCulloch, RN, CCM, MSCC, LNC – ISG May 3, 2021 Although the long-term effects of Covid-19 are still unknown, one area of the body seems particularly susceptible to complications: the respiratory system. Causing a wide range of respiratory symptoms such as coughing and shortness of breath, the virus can be spread through the air…