12.5.2019 Blog

Today, CMS announced two town hall meetings taking place on January 14, 2020, to discuss topics related to recovery processes of the Commercial Repayment Center (CRC), the branch of CRC responsible for collecting reimbursement of Medicare conditional payments from insurance carriers and self-insured entities. On that date at 1:00 PM EST (12:00 PM CST), a town hall meeting will address Non-Group Health Plans (which include workers’ compensation, liability, and no-fault claims) with a focus on the topic of Ongoing Responsibility for Medicals (ORM). A second town hall meeting will follow at 2:00 PM EST (1:00 PM CST) and will focus on Group Health Plans. Complete details for these meetings can be found on the CMS website here. We strongly encourage all of our clients and friends to participate in these meetings to provide input that will protect our rights as CMS reviews its operating procedures and policies.

Earlier this week, CMS also issued an Alert stating that the low-dollar review thresholds for most liability, no-fault, and workers’ compensation cases will remain at $750.00. This update is effective January 1, 2020, and impacts both Section 111 reporting requirements and CMS recovery actions. If the Total Payment Obligation to the Claimant (TPOC) is $750.00 or less, and if the responsible entity (insurer or self-insured) does not have ongoing responsibility for medicals, then the claim does not need to be reported to CMS under Section 111, and CMS will not seek recovery of conditional payments from such settlements. Please note that for liability cases, this threshold only applies to physical trauma-based settlements, and does not apply to settlements for alleged ingestion, implantation, or exposure cases. The full Alert can be viewed here. We at Nyhan Bambrick Kinzie & Lowry welcome any questions or comments about these developments, and we are available to discuss your Medicare Secondary Payer compliance needs any time!

The NBKL blog is provided for informational purposes; we are not giving legal advice or creating an attorney/client relationship by providing this information.  Before relying on any legal information of a general nature, you may consider consulting legal counsel as to your particular facts and applications of the law.