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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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Required statement from the AL State Bar:  No representation is made that the quality of legal services to be performed is greater than the quality of legal services provided by other lawyers.  Any recoveries and testimonials are not an indication of future results. Every case is different, and regardless of what friends, family, or other individuals may say about what a case is worth, each case must be evaluated on its own facts and circumstances as they apply to the law. The valuation of a case depends on the facts, the injuries, the jurisdiction, the venue, the witnesses, the parties, and the testimony, among other factors.  Disclaimer.

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