Two state insurance guarantee funds challenged CMS’ definition of a “primary plan” in order to exclude themselves from conditional payments and Section 111 reporting...

  One of the challenging tasks for MSA allocators is persuading CMS to exclude a surgical allocation when a future surgical procedure is mentioned in...

  On October 5, 2020, CMS released version 3.2 of its Workers’ Compensation Medicare Set-Aside (WCMSA) Reference Guide.  One of the changes provided further guidance...

  Medicare coverage is not limited to Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). Medicare Advantage Plans (Part C) are also an...

  I recently wrote about Section 111 Total Payment Obligation to Claimant (TPOC) reporting in bifurcated settlements. Given the ambiguity in the NGHP User Guide,...