Blog
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Health and Human Services No Longer Applying Richardson Waiver
By P. Czuprynski On March 3, 2025, the U.S. Department of Health and Human Services (HHS) published a policy statement advising that HHS will no longer apply the “Richardson Waiver”...
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The New Medicare? A Rise in Medicare Advantage Enrollment: What You Need to Know
Senior Vice President Bridget Smith recently wrote two articles for WorkCompWire’s Leaders Speak feature, the first of which was The New Medicare? A Rise in Medicare Advantage Enrollment: What...
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The Wait is Over: CMS Change to Amended Review Timing Begins in April
By M. Heberling April will bring impactful changes to the Centers for Medicare & Medicaid Services (CMS) review process. We wanted to highlight these changes and make sure your organization...
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CMS Updates Amended Review Submission Criteria
by B. Smith On January 21, 2025, CMS issued a separate alert noting the changes to the zero-dollar MSA review process (see our separate blog on this topic here), and...
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CMS Issues New Guidance on Zero-Dollar WCMSAs and Updates Calculation Methods for Intrathecal Pumps
by B. Smith & C. Chovanec The Centers for Medicare and Medicaid Services (CMS) issued a new Workers’ Compensation Medicare Set-Aside Reference Guide version 4.2, dated January 17, 2025. Updates...
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CMS Releases Section 111 NGHP User Guide Version 7.9
by J. Shymanski CMS released version 7.9 of the Non-Group Health Plan (NGHP) User Guide yesterday. The only update in version 7.9 reflects the notice that CMS issues each year regarding...
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CMS Maintains $750 Recovery Threshold for 2025
CMS is required to publish an annual threshold for recovery each year. This threshold amount reflects an amount for which CMS will not spend more on collections than a...
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CMS Issues NGHP User Guide Version 7.8
by B. Smith The Centers for Medicare & Medicaid Services (CMS) has issued a new Non-Group Health Plan (NGHP) User Guide, Version 7.8. CMS added a new language in Chapter...
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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...