Conditional Payments / Lien Resolution
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Medicare Advantage Plans: Navigating Conditional Payment Appeals
by P. Czuprynski Federal regulations require Medicare Advantage Plans (MAPs) establish an administrative appeal process that allows a Qualified Independent Contractor, an Administrative Law Judge, the Medicare Appeals Council, and...
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How Healthy Are Your Tax Identification Number (TIN) Reference Files?
by P. Czuprynski Responsible Reporting Entities (RREs) need to report Ongoing Responsibility for Medical (ORM) or Total Payment of Obligation to Claimant (TPOC) associated with a workers’ compensation or liability...
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CMS to Increase Availability of “Fixed Percentage” Option for Reimbursement of Conditional Payments
by Settlement Consulting Team Medicare recently issued a notice that the requirements associated with the fixed percentage approach to resolving conditional payments associated with certain settlements are changing. Effective October 2,...
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Exploring Conditional Payment Litigation
by P. Czuprynski On 7/12/2023, IMPAXX continued its knowledge series on Medicare Secondary Payer Compliance. In our latest session, Lights, Camera, Action: Exploring Conditional Payment Litigation, we discussed recent federal...
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CMS Releases NGHP Appeals Reference Guide 1.0
by B. Smith The Centers for Medicare & Medicaid Services (CMS) recently released the first Non-Group Health Plan (NGHP) Applicable Plan Appeals Reference Guide, Version 1.0 (Guide) dated April 27,...
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Exploring Different Processes for Medicare Liens: Parts A, B, C, and D
P. Czuprynski Earlier in March, as part of our complimentary knowledge series of webinars on Medicare Secondary Payer Compliance, we reviewed the different search and collection processes for Medicare Parts...
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Medicare Issues Group Health Plan (GHP) Defense Reference Guide
by P. Czuprynski Recently, Medicare issued a reference guide associated with conditional payment recovery related to group health plan claims. So, if a person has group health coverage AND Medicare...
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Conditional Payments: Recent Wins
By P. Czuprynski After administrative appeals, IMPAXX recently won two claims associated with conditional payments. In both cases, Adjudicators (ALJ) with the Office of Medicare Hearing and Appeals determined Medicare...
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Medicare Secondary Payer Recovery Portal “Go Paperless” Webinar Highlights
By P. Czuprynski The Centers for Medicare & Medicaid Services (CMS) hosted a webinar to discuss its option for carriers, self-insureds, or their recovery agents to obtain service of conditional...