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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
On November 17, 2016, CMS will host a Town Hall teleconference for the purpose of discussing the following topics: 1. Ongoing Responsibility for Medicals (ORM) recovery; 2. Final Conditional Payment (CP) process reminders; and 3. Medicare Secondary Payer Recovery Portal (MSPRP) improvements. If you have any questions or concerns, you can submit them prior to […]
The presentation from the May 5th webinar regarding Establishing Appeal Rights for Applicable Plans, Including Liability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers’ Compensation Laws or Plans Presentation is now available in the Downloads section of the Insurer Services What’s New page of CMS.gov. The following link can be used to access the page http://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/InsurerServices/Whats-New.html.