Tag Archive: Conditional Payments
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CMS Updates NGHP User Guide to Version 8.4
by F. Fairchok The Centers for Medicare & Medicaid Services (CMS) released an update to the Non-Group Health Plan (NGHP) Section 111 Reporting User Guide on April 13, 2026. The...
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Good-Faith Dispute Over Workers’ Compensation Coverage Defeats Double Damages Suit by Medicare Advantage Plan
by P. Czuprynski In Bronson Healthcare Group, Inc. v. Conifer Insurance Company, 2026 Mich App Lexis 924, 2026 WL 271561 (decided 2/2/2026), a Medicare Advantage Plan (MAP) was seeking double...
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Medicare Advantage Plan’s Conditional Payments Limited by New York Laws
by P. Czuprynski In Claims v. Merchs. Mut. Ins. Co.[1], the Court partially denied Medicare Advantage Plan’s suit over conditional payment reimbursements and highlights a possible defense for carrier/self-insureds to...
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Is Medicare Denying Payment for Treatment Under the MSP Act for Workers’ Compensation and Liability Claims?
by P. Czuprynski The Medicare Secondary Payer (MSP) Act allows Medicare to make payment and then seek reimbursement for Conditional Payments. This occurs when Medicare asks for reimbursement associated with...
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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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CMS Launches New NGHP Civil Money Penalties Webpage
by B. Smith The Centers for Medicare and Medicaid Services (CMS) has launched a new webpage regarding Section 111 Civil Money Penalties (CMPs) for Non-Group Health Plans (NGHP). The webpage...
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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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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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Eleventh Circuit Holds Section 111 Reporting Can Establish Elements of Private Cause of Action Under MSP Act
by B. Smith The Eleventh Circuit Court of Appeals in MSP Recovery Claims, Series LLC v. Metropolitan General Insurance Company, et. al., Case No. 21-11547 (11th Cir. July 18, 2022),...