CMS Releases Recovery Thresholds for Non-Group Health Plan Cases


CMS recently released the results of its ‘Computation of Annual Recovery Thresholds for Certain Liability Insurance, No-Fault Insurance, and Workers’ Compensation Settlements, Judgments, Awards, or Other Payments.’

According to the report from the CMS Financial Services Group, the average cost of collection for Non-Group Health Plan (NGHP) cases (liability insurance and self-insurance, no-fault insurance, and workers’ compensation) is $297 per case. This calculation was based on data collected by CMS between August 2017 and July 2018.

Based on the cost of collection, CMS determined that it will maintain a $750 reporting threshold for liability and workers’ compensation settlements as well as for no-fault insurance settlements in which the insurer has no ongoing responsibility for medicals.

Beginning January 1, 2019, liability, workers’ compensation, and no-fault settlements of $750 or less need not be reported to Medicare, and Medicare’s conditional payment amount related to these cases will not need to be repaid.

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