Conditional Payments / Lien Resolution
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IIGF is Not a Primary Payer Under the Medicare Secondary Payer Act
by P. Czuprynski In IIGF v. Becerra[1] the United States District court for the Northern District of Illinois determined conditional payments alleged by Medicare, did not require reimbursement by IIGF...
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Administrative Procedure Act: Medicare, Medicare Advantage and Prescription Plans Must Follow its Regulations
With Chevron Deference being overturned, stakeholders facing conditional payment demands or payment denials by Medicare have a better chance of success in challenging Medicare’s decision. Federal district court review of...
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Understanding Medicare’s Three-Year Dates of Service Limitation
by P. Czuprynski The Medicare Secondary Payer Act requires reimbursement from an insurer or self-insured entity associated with a workers’ compensation, or a liability claim when there is (1) reasonable...
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CMS Issues NGHP Secondary Payer Reference Guide for Beneficiaries
by P. Czuprynski The Centers for Medicare & Medicare Services (CMS) has released version 1.0 of its Non-Group Health Plan (NGHP) Medicare Secondary Payer (MSP) Beneficiary Reference Guide pertaining to...
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Conditional Payment Case Update: Angelo Et Al v. State Farm Mutual Automobile Insurance Company Et Al
by P. Czuprynski In Angelo et al v. State Farm Mutual Automobile Insurance Company et al, No.2:19cv12165, U.S. Dist. E.D. Mich. Southern Div. (3/26/2024), the Federal District Court in Michigan...
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Medicare Provides Forms to Close CRC and BCRC Cases
by P. Czuprynski On May 13, 2024, Medicare issued two new forms that can be used to request that Medicare close a Commercial Repayment Center (CRC) or Benefits Coordination &...
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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,...