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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 […]

Shark Week ICD-10 Codes

Every year, the Discovery Channel has a week of programming dedicated to sharks and shark documentaries. While it is imperative to know when and how to utilize the ICD-9-CM and ICD-10-CM codes, it is also interesting to understand the amount of codes at your disposal, such as those related to Shark Week. As background, ICD […]

Centers for Medicare and Medicaid December 24, 2015 Alert

On December 24, 2015, the Centers for Medicare and Medicaid Services released an Alert titled “Changes to Medicare Claim Payments Where Ongoing Responsibility for Medicals (ORM) is Reported.” Effective January 1, 2016, in situations where an insurer has reported to CMS that it has ongoing responsibility for medicals for specific care or an injury, CMS’ […]

Non-Group Health Plan ORM Recovery Workload Transition Webinar September 17, 2015

Today, the Centers for Medicare & Medicaid Services (“CMS”) provided the following notice regarding “Non-Group Health Plan ORM Recovery Workload Transition Webinar.” As part of the continuing efforts to improve the Coordination of Benefits & Recovery (“COB&R”) program and claims payment accuracy in Medicare Secondary Payer situations, the Centers for Medicare & Medicaid Services will […]

Medicaid is Becoming More Aggressive: Recent Correspondence from Mississippi Medicaid

Attorneys involved in a settlement, judgment, or other award must be aware that Federal and/or State Medicaid may have a right to reimbursement from those proceeds. State Medicaid Agencies are becoming more aggressive. On July 17, 2015, the Mississippi Division of Medicaid (“DOM”) issued correspondence to every member of the Mississippi Bar. The correspondence noted […]

Kentucky Workers’ Compensation Insurance Questionnaire

Medicaid third party liability reporting is increasing through insurance questionnaires, and we are seeing it firsthand in Kentucky. Our firm has been provided information that Kentucky has been requesting a workers’ compensation insurance questionnaire from insurance payers with regard to each of its injured workers to identify Medicaid beneficiaries. If you have received one of […]

Proposed Rule Involving Medicaid Recoveries

The Centers for Medicare and Medicaid Services (“CMS”) is proposing adjustments to the future Medicaid recovery processes. The proposal comes from the Medicaid and Children’s Health Insurance Program (“CHIP”) Programs: Medicaid Managed Care, CHIP Delivered in managed Care, Medicaid and CHIP Comprehensive Quality Strategies, and Revisions Related to Third Party Liability. The proposed rule is […]