Physical trauma-based NGHP reporting threshold remains at $750 in 2019

As required by section 1862(b) of the Social Security Act, the Centers for Medicare and Medicaid Services (CMS) has reviewed the costs related to collecting Medicare’s conditional payments and compared this to recovery amounts. The full report, released November 15, 2018, is available here. As a result of the computation, the threshold for physical trauma-based liability insurance settlements will remain at $750 in 2019.

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Major Changes to Conditional Payment Reimbursement Process for Entities that Have Accepted ORM

As those of you who follow us regularly on this blog know, on August 5, 2015, we anticipated that after the Center for Medicare and Medicaid Services (CMS)’ announcement of the transition to the Commercial Repayment  Center (CRC) for reimbursement of conditional payments (CP) directly from applicable plans (AP) who have accepted ongoing responsibility for … Read moreMajor Changes to Conditional Payment Reimbursement Process for Entities that Have Accepted ORM

Despite Settlement, Which Included Resolution of Conditional Payments, Florida Federal District Court Finds Insurer to be Primary Payer and Awards Double Damages to MAP

On March 16, 2015, the United States District Court for the Southern District of Florida published its opinion on Humana Medical Plan v. Western Heritage Insurance Company, finding that as a matter of law, Humana is entitled to maintain a private cause of action for double damages pursuant to 42 U.S.C. § 1395y(b)(3)(A) against Western … Read moreDespite Settlement, Which Included Resolution of Conditional Payments, Florida Federal District Court Finds Insurer to be Primary Payer and Awards Double Damages to MAP

Summary of Final Rule: Conditional Payment Appeals Process for Applicable Plans

On February 27, 2015, CMS published in the Federal Register the SMART Act Appeal Final Rule which can be located at 80 Fed. Reg. 10611. The rule can be found here and will go into effect on April 28, 2015. CMS had previously issued the Proposed Rule on this very topic on December 27, 2013. Materially, the … Read moreSummary of Final Rule: Conditional Payment Appeals Process for Applicable Plans

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