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…
Joanne McCulloch, RN, CCM, MSCC, LNC – ISG April 28, 2021 The Centers for Medicare and Medicaid Services (CMS) released a new WCMSA Reference Guide version 3.3 on April 19, 2021 and can be found here. This update replaces the prior version of WCMSA Reference Guide 3.2 from October 2020. Newest updates include: The…
Sam Crepeau – Medicare Compliance Counsel, ISG April 27, 2021 CMS has announced that it will be hosting another town hall presented by representatives from the BCRC and CRC to cover Group-Health Plan (GHP) topics on May 19th at 1:00PM est. The announcement (which can be found here) has no particular agenda of topics to…
Sam Crepeau – Medicare Compliance Counsel, ISG April 21, 2021 CMS has long published model language for RREs to collect beneficiary status information from Claimants to assist RREs with their Section 111 Mandatory Insurer Reporting obligations. The Model Language asked the person if they were on Medicare Part A or B, notably not providing an…
Katie Fox, EVP Medicare Compliance, MSCC, CMSP April 6, 2021 Today, CMS released the first of several anticipated NGHP User Guide updates. While we have not seen the PAID Act implementation yet, that is sure to come soon. For today’s release, we offer the following preliminary thoughts on the updates to the User Guide by…