CMS Update: Section 111 NGHP User Guide
On July 13, 2015, CMS issued an updated Section 111 NGHP User Guide. In an effort to prevent false positives in partial SSN searches, CMS...
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Melisa Zwilling
Jul 17, 2015
CMS Alert: ICD-10 Reporting Reminder
CMS issued an alert as a reminder that Responsible Reporting Entities and their agents must report ICD-10-CM diagnosis codes on claim...
Melisa Zwilling
Jul 16, 2015
Melisa Zwilling Set to Speak at National Conference in November
Melisa C. Zwilling will be presenting at the 24th Annual National Workers' Compensation and Disability Conference® in Las Vegas, November...
Melisa Zwilling
Jul 9, 2015
Eleventh District Court Dismisses MAO Private Cause of Action
Medicare Advantage Organizations (MAOs) right to recovery under the private cause of action provision of the Medicare Secondary Payer Act...
Melisa Zwilling
Jul 8, 2015
CMS Announces Transition of NGHP recovery to Commercial Repayment Center
Currently, Medicare's Benefits Coordination and Recovery Center (BCRC) handles the recovery of conditional payment claims in workers'...
Melisa Zwilling
Jun 24, 2015
Section 111: Rule on Penalties Not Expected Until December 2016
Under the SMART Act, CMS is supposed to issues rules specifying "practices for which sanctions will and will not be imposed." In...
Melisa Zwilling
Jun 19, 2015
IMRs in California Accepted by CMS in Carr Allison MSA Allocations
Under California workers' compensation law, as of July 1, 2013, medical treatment disputes for all dates of injury are resolved through...
Melisa Zwilling
Jun 18, 2015
CMS Alert: Matching Criteria for SSNs
On June 18, 2015, CMS issued an Alert entitled "Modification of Matching Criteria Used When Reporting Partial Social Security Numbers for...
Melisa Zwilling
May 28, 2015
Michigan Court of Appeals Allows Plaintiff to Pursue Private Cause of Action against No-Fault Insure
In Holmes v. Farm Bureau Gen. Ins. Co., No. 320723, 2014 Mich. App. LEXIS 1031 (Mich. Ct. App. May 19, 2015), Holmes was injured in a...
Melisa Zwilling
May 12, 2015
Summary: CMS Applicable Plan Appeals Webinar
In case you missed the webinar on May 5, 2015, we have provided a summary of the webinar below: CMS held a webinar to discuss the new...
Melisa Zwilling
May 6, 2015
CMS Reschedules Appeal Rights Webinar
CMS announced today that they have rescheduled the webinar on Applicable Plan Appeal Rights for May 5, 2015 at 1:00 PM EST. Participats...
Melisa Zwilling
Mar 18, 2015
District Court in the Eleventh Circuit Gives Humana a Private Cause of Action Under the MSP
Courts continue to follow the Third Circuit’s lead by finding that Medicare Advantage Organizations (MAO) have a private cause of action...
Melisa Zwilling
Mar 2, 2015
CMS Update: WCMSA Life Expectancy Calculations
As of April 1, 2015, CMS will begin referencing the CDC's Table 1: Life Table for the total population: United States, 2010, for WCMSA...
Melisa Zwilling
Mar 2, 2015
CMS Issues Final Rule: Conditional Payment Appeals Process
On February 26th, 2015, CMS issued a final rule implementing provisions of the Strengthening Medicare and Repaying Taxpayers Act (the...
Melisa Zwilling
Feb 5, 2015
CMS Issues Updated Section 111 User Guide
On February 2, 2015, CMS issued an updated Section 111 NGHP User Guide incorporating the following language from the August 19, 2014,...
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