Archive by Author

Defintions that Should be Known for Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007

Filing a Non-Group Health Plan (“NGHP”) report under Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) can be a very complicated process without the proper understanding of Medicare’s definitions, which can vary from other industries.  The multitude of uncommon and unfamiliar terms in one place makes the reporting process seem nearly […]

Do You Have a New Medicare Number?

The simple answer is yes. The Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act (MACRA) of 2015 required the Centers for Medicare and Medicaid Services (“CMS”) to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019. A new Medicare Beneficiary Identifier (MBI) will replace the SSN-based Health Insurance Claim Number […]

How A Special Needs Trust Can Protect Your Client

When you have a client that is receiving government benefits, such as Medicaid, you probably need to advise them to consider distributing a portion of the settlement proceeds or estate funds into a Special Needs Trust. “A trust is an arrangement for dividing the ownership of assets from management of those assets, and it usually […]

Medicare and Medicaid Law by Newsom Law

Notice of Proposed Rulemaking Civil Monetary Penalties

The Office of Management and Budget issued a Notice of Proposed Rulemaking relating to Section 111 civil penalties for late reporting, titled: “Civil Monetary Penalties (CMPs) and Medicare Secondary Payer Requirements.”  As required by the Strengthening Medicare and Repaying Taxpayers Act of 2012 (SMART Act), CMS is required to establish criteria and practices in which […]


Shark Week and ICD-10 Coding Collide

Every year, the Discovery Channel has a week of programming dedicated to sharks and shark documentaries. So, I will provide a fun and interesting article combining the two for Shark Week. As background, ICD stands for International Statistical Classification of Diseases and Related Health Problems. ICD-10 was developed by the National Center for Health Statistics […]

Medicare Scams for Personal Information

New Medicare numbers are being issued.  The new Medicare Number is being called the Medicare Beneficiary Identifier, which is replacing the current Social Security-based Health Insurance Claim Number (HICN) on Medicare health insurance cards.  New Medicare beneficiaries will receive the Medicare Beneficiary Identifier first. In preparation, the Centers for Medicare and Medicaid Services advised of […]

Medicare law by Newsom Law

Emotional Distress is an Injury that Must be Reported Under Section 111

The purpose of the Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 reporting process is to enable the Centers for Medicare & Medicaid Services to pay for Medicare covered items and services furnished to Medicare beneficiaries by determining primary versus secondary payer responsibility. Section 111 reporting requirements apply when a person […]

New Section 111 reporting thresholds

The Centers for Medicare and Medicaid Services posted the following Alert on September 26, 2016 with updated thresholds for Section 111 reporting. As background, on December 29, 2007, President George Bush signed into law the Medicare Medical, and SCHIP Extension Act of 2007. The purpose of the Section 111 Medicare Secondary Payer reporting process is […]