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Medicare Secondary Payer (MSP) NGHP Reporting Entities CMS Update Alert

CMS: NGHP Responsible Reporting Entities (RREs) that both Med Pay andPersonal Injury Protection (PIP) coverage should be included when reporting the No-Fault Insurance Limit (Field 61 of Claim Input File). As such, NGHP RREs must combine both Med Pay and PIP coverage limits for a policy when they are separate coverages being paid out on […]

CMS finalizes Workers Comp Set aside regulations

CMS has issued new regulations regarding Medicare Workers Compensation Set Asides, while these do not as yet apply to Liability settlements, they are informative. See Version 3.1 of the WCMSA Reference Guide has been posted to the Downloads section of the Workers’ Compensation Medicare Set Aside Arrangements page on CMS.gov. Refer to Section 1.1 for a summary of updates.

Medicaid TPL Rights Postponed

In 2006 the United States Supreme Court decided Ahlborn v. Arkansas 547 U.S. 268 (2006). There, the Court in interpreting Medicaid’s long standing statutory rights of recovery held that from an unallocated third party settlements, Medicaid was only entitled to recover that portion of  an unallocated settlement that represented past medicals.  Thus extinguishing Medicaid’s long standing, […]

FEHBP Plans Not Subject to State Laws

FEHBP Plans Not Subject to State Laws Coventry Health Care of Missouri, Inc. v. Nevils April 18, 2017 S. Sup. Ct. 16–149 The U.S. Supreme Court ruled yesterday that Contractual subrogation and reimbursement rights of federal employees’ private health insurance carriers override state laws barring subrogation and reimbursement (Ginsburg, J.) In a unanimous decision, the […]

WC Carriers allowed indirect Third Party Subrogation claim against third parties

Pa highest court clarifies road map for Workers Comp  carriers to protect Subrogation claims.   The Honorable Judge Olson has clarified the “Magic words “ by which a  Workers Comp Carrier in Pennsylvania can assert a Subrogation claim against a Third Party pursuant to the much litigated Section 319 of the Pa Workers Comp Act.  […]

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