Tag Archive: Medicare
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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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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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Will Lower Drug Price Negotiations Impact MSAs?
by B. Smith In a press release issued this month, CMS noted that the Biden-Harris Administration reached an agreement for lowering pricing on 10 select medications. This new pricing will...
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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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CMS Releases Updated Self-Administration Toolkit Version 1.5
by J. Shymanski While dated May 15, 2024, the Centers for Medicare & Medicaid Services (CMS) released version 1.5 of the Self-Administration Toolkit for Workers’ Compensation Medicare Set-Aside Arrangements (WCMSAs)...
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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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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: Is Medicare’s Reopen Process Right For You? Which Regulation Can Medicare Ignore?
On November 17, 2016, Medicare states the following during a townhall presentation, click here for link to transcript. As many of you may be aware the CRC systematically filters all...