CMS to Host Webinar on Introduction to WCMSAs on June 17

June 12, 2025

Woman watching a CMS webinar on her laptop and taking notes.

The Centers for Medicare and Medicaid Services (CMS) will host an Introduction to Workers’ Compensation Medicare Set-Asides (WCMSAs) webinar on Tuesday, June 17, 2025, at 2:00 p.m. ET.

Per CMS: the purpose of the webinar is to “…go over the basics of WCMSAs including purpose, submission guidelines and administration as well as to offer some WCMSA best practices.”

This session is designed to provide clarity on the Workers’ Compensation Medicare Set-Aside (WCMSA) process, including its purpose, submission guidelines, and administration. Attorneys, Medicare beneficiaries, and other professionals involved in the submission and administration of WCMSAs are encouraged to attend. Please note that this session will focus on general information only; discussions pertaining to specific cases are not appropriate for the webinar.

Following the presentation, a question-and-answer session will be held.

There is no pre-registration for the webinar. Full details, including instructions on how to submit questions before the webinar, can be found here and in the “What’s New” section of the CMS website.

Tower MSA Partners Announces Acquisition of Axiom National

May 2, 2025

Tower MSA Partners logo.

Tower MSA Partners (“Tower”), a portfolio company of Ambler Brook, is excited to announce the acquisition of Axiom National, a Tampa, FL-based provider of Medicare Secondary Payer (“MSP”) compliance and settlement planning solutions. This strategic move expands Tower’s market leadership across all segments of the MSP market as one of the largest dedicated providers of technology-driven MSP compliance solutions to self-insured enterprises, carriers and third-party administrators.

Tower provides its customers with an integrated suite of automation technology and services to deliver MSP Compliance Solutions, including Section 111 Reporting, Medicare Set-Aside processing, Medicare Lien Research and Resolution, CMS Submittal, Amended Reviews, and Medical Cost Projections.

“Tower shares Axiom’s values of providing high-touch MSP compliance solutions,” said Geoffrey Hudson, CEO of Axiom National. “As we join the Tower platform, our customers will benefit from Tower’s expanded technology and service offerings, including physician follow-up service, Section 111 Mandatory Insurer Reporting, enterprise-level security, and industry-leading customer support.”

“We appreciate our partnership with Geoffrey and are excited to welcome Axiom’s customers to the Tower family as they will now have access to our integrated suite of MSP compliance solutions, exceptional customer service, deep regulatory expertise and settlement solutions that our customers have relied on us to provide for over a decade,” said Kristine Dudley, Tower’s Co-Founder and Chief Operating Officer.

“The acquisition of Axiom aligns with our growth strategy, positioning us as the preferred acquirer of providers of MSP compliance, settlement and other cost-containment solutions sold into self-insured enterprises, carriers and third-party administrators,” added Dan Anders, Tower’s Chief Compliance Officer. “Tower offers a robust platform for these providers to expand and better serve their customers in a dynamic technology landscape.”

About Tower MSA Partners

Tower MSA Partners, LLC, a leading provider of Medicare Secondary Payer (“MSP”) compliance technology and services to the country’s largest self-insured enterprises, carriers and third-party administrators.  Tower’s services include Section 111 Mandatory Insurer Reporting, conditional payment resolution, and Medicare Set-Aside optimization and preparation. Led by a management team with decades of regulatory and legal expertise, Tower’s automation suite enables it to provide industry-leading compliance and regulatory solutions to facilitate fast, compliant, and cost-effective savings for its clients. To learn more about Tower MSA Partners, please visit: https://towermsa.com/

Media Contact:

Dan Anders
Chief Compliance Officer, Tower MSA Partners

888.331.4941
daniel.anders@towermsa.com

CMS Implements WCMSA Reporting and Eliminates Amended Review Wait Time

April 10, 2025

Person reviewing WCMSA report with a magnifying glass.

CMS is implementing important changes that impact how workers’ compensation Medicare Set-Aside (WCMSA) amounts are reported and how Amended Reviews are managed. These updates are outlined in the latest revisions to CMS’s user and reference guides.

Key Updates and Important Dates

  • Effective April 4, 2025:
    CMS has begun requiring Section 111 reporting for workers’ compensation MSAs for TPOC dates of April 4, 2025 and later. All relevant guides now reflect the updated WCMSA reporting requirements tied to this start date.
  • Elimination of the One-Year Waiting Period:
    Previously, once an MSA was approved, a waiting period of one year was required before an Amended Review could be submitted. With the new changes, an Amended Review MSA can now be submitted at any time after approval as long as the other criteria are met.

What’s New in the CMS Guides?

Section 111 Mandatory Insurer Reporting User Guide (Version 8.0)

  • Updated Field Numbers:

Field numbers have been updated throughout the user guide to align with the WCMSA reporting requirement effective April 4, 2025.

  • Clarification on Reporting Thresholds:

In Chapter IV, under Technical Information (Section 6.4 – TPOC Reporting), the guide now clearly states that the $750 reporting threshold applies to non-trauma (alleged ingestion, implantation or exposure incident) no-fault as well as workers’ compensation cases.

  • Additional MSA Correction Scenarios:

Three new scenarios have been added to the event table in Section 6.6.4. These are specific to errors or corrections linked to WCMSA reporting.

  • Enhanced Appendices:
  • The guide’s Appendices A, B, and G include updated reporting requirements. Notably, ZIP+4 guidance has been improved. Additionally, effective October 6, 2025, if an agent’s name is provided in the submission, the Recovery Agent TIN field is now mandatory.

WCMSA Reference Guide (Version 4.3)

  • Settlement Notification Updates:
    A “Notice of Settlement Received” letter has been introduced in Appendix 5. Whenever a WCMSA is reported, CMS will issue this letter to the claimant. This requirement applies even to MSAs that are not CMS-approved, ensuring that all claimants receive appropriate notification and that annual attestations are submitted for documented expenditures.
  • Streamlined Amended Review Process:
    Along with removing the one-year wait, Sections 16.3 and 19.4 now clarify that the change of submitter policy applies to Amended Review MSAs as well. This allows for greater flexibility in managing and updating MSAs after they have been approved. See Tower article here on Amended Reviews.

WCMSA Self Administration Toolkit (Version 1.7)

  • Reference-Only Guidance:
    The toolkit now clearly states that it is a reference manual—not an exhaustive step-by-step guide—to assist users with WCMSA administration.
  • WCMSA Basics Introduction:
    A new section introduces the fundamentals of WCMSA administration, making it easier for users to understand the process from the beginning.
  • Portal Access Instructions:
    Detailed instructions and a screenshot now guide users on how to access the WCMSA portal on Medicare.gov for submitting their annual attestation.
  • Removal of the Inheritance Section:
    The previously included section on what happens to the MSA funds after the Medicare beneficiary’s death has been removed. It is unclear why this was removed as it provided instructions on how the MSA funds are to be handled after the Medicare beneficiary dies (There remain instructions in Section 19.2 of the WCMSA Reference Guide on what happens to the MSA funds post-death).

Questions or More Information?

For any questions regarding these updates or for further assistance, you can reach out to Tower MSA Partners’ Chief Compliance Officer, Dan Anders, at 888.331.4941 or via email at daniel.anders@towermsa.com.

 

October CMS Updates: Section 111 Reporting User Guide and Civil Money Penalties Webinar Highlights

October 31, 2024

CMS Webinar Highlights | Section 111 Reporting User Guide & Civil Money Penalties

Section 111 Reporting User Guide and Civil Money Penalties Webinar Highlights

Stay up-to-date with the latest CMS developments!  This month, we’re covering the release of the NGHP Section 111 Reporting User Guide Version 7.7, the annual update to the ICD exclusion list, and key insights from the CMS Section 111 Civil Money Penalties webinar.

NGHP User Guide Version 7.7 Released

On October 7, 2024, CMS published Version 7.7 of the NGHP (Non-Group Health Plan) Section 111 Reporting User Guide.  Here are notable updates:

Reporting of Wrongful Death Claims

In Chapter III; Policy Guidance, Section 6.5.1.4, CMS provided the following clarification:

“Note: Settlements, judgments, awards, or other payments obtained entirely under the wrongful death theory of liability, which do not claim and release medicals, or have the effect of releasing medicals, are not required to be reported because Medicare would have no recovery claim against such a payment.”

This statement is consistent with CMS’s previous guidance that Total Payment Obligation to Claimant (TPOC) amounts are reported only when medicals are claimed and/or released, or the settlement has the effect of releasing medicals.

Compliance Flags are now Warning Flags

In Chapter IV: Technical Information, CMS has renamed “Compliance Flags” in Section 7.4 to “Warning Flags.” Additionally, a new “04” warning flag has been introduced. This flag applies to claim response files with open Ongoing Responsibility for Medicals (ORM) records when the later date of either the CMS Date of Incident or the Part A Add Date is more than 135 calendar days after the Start Date of the Responsible Reporting Entity’s (RRE’s) submission period.

Understanding Warning Flags and Penalties

It’s important to note that warning flags do not necessarily equate to a potential civil monetary penalty for late Section 111 reporting.  Here’s the key difference:

  • Warning Flags: Triggered if ORM or TPOC is reported more than 135 days after it should have been reported, as defined in the user guide.
  • Penalties: Potential penalties don’t come into play until 365 days have passed since the date the information should have been reported.

Why the different timeframes?  We assume it is to encourage RREs to report promptly, ensuring CMS has the necessary information to coordinate benefits properly.  Warning flags act as a reminder to the RRE that repeated reporting delays could lead to more significant issues, including potential penalties.

Updated ICD Code Excluded List

CMS published its annual update of valid and excluded liability and no-fault ICD-9 and ICD-10 codes for Section 111 reporting purposes. The list can be found here.

CMS Webinar Highlights: Section 111 Civil Money Penalties

On October 17, 2024, CMS hosted a webinar on Section 111 Civil Money Penalties.  The webinar slides can be found here.  Key takeaways:

  • Civil Money Penalty Correspondence: Notices will be mailed to the RRE’s Authorized Representative and the Account Manager.  Reporting agents, such as Tower MSA Partners, will not receive a copy of the notice.  Therefore, it is important for the RRE to ensure address information is up-to-date.
  • Compliance Clock Started: The compliance clock began ticking on October 11, 2024.  Eligible MSP occurrences occurring on or after this date must be reported within 365 days.
  • Obtaining Beneficiary Information: When trying to gather beneficiary details, such as a Social Security Number, the RRE must reach out to both the beneficiary and, if applicable, their attorney. Contacting only the attorney isn’t sufficient. Additionally, you must make at least three attempts to obtain the information, with at least two attempts made via mail or email.

If you have any questions about these updates, please contact Tower’s Chief Compliance Officer, Dan Anders, at daniel.anders@towermsa.com.

Significant Changes Coming to Florida Fee Schedule: What It Means for Your MSA Costs

October 24, 2024

Florida State Capital building

Florida’s 2025 Fee Schedule Changes Will Raise MSA Costs

Starting January 1, 2025, Florida is making some significant changes to its fee schedule, which will lead to higher MSA (Medicare Set-Aside) costs – sometimes significantly so. Here’s what you need to know.

Increased Physician Reimbursement Rates in Florida’s New Fee Schedule

In June 2024, the governor signed a new law that increases the maximum reimbursement rates for physicians and surgical procedures. For doctors, the rates will jump from 110% to 175% of the Medicare allowable reimbursement rate, while surgical procedures rates will rise from 140% to 210%. The Florida Association of Orthopaedic Executives said “that represents an unprecedented increase in physician reimbursement of 59% for non-surgical codes and 50% for surgical care.”  These rates haven’t changed in 20 years, and Florida is presently the lowest in the nation.

How Florida’s New Fee Schedule Affects MSA Pricing

What does this mean for MSAs? Since MSA pricing is based on the relevant workers’ compensation fee schedule, there is an opportunity to lock in lower costs for Florida MSAs if you get CMS approval before January 1, 2025.

What Should You Do?

  • Already Have an MSA Prepared? If Tower has already prepared a Florida MSA for you and the estimated settlement exceeds CMS MSA review thresholds, submit it as soon as possible to achieve cost-savings.
  • No MSA Yet, But Settlement Coming Soon? If you’re expecting a settlement in the coming months, now is the time to get an MSA prepared and submitted for approval.

Remember, once CMS approves an MSA, that approval does not expire.  So, even if settlement occurs after the fee changes, the approved MSA amount remains valid.

If you have any questions, feel free to reach out to Tower’s Chief Compliance Officer, Dan Anders, at daniel.anders@towermsa.com. And, if you’re ready to move forward with a Florida MSA submission or preparation, please contact us at referrals@towermsa.com.

CMS Sets October 17 for Webinar on Section 111 Reporting Penalties

October 9, 2024

CMS Webinar on Section 111 Reporting Penalties

Upcoming CMS Webinar on Section 111 Reporting Penalties

The Centers for Medicare and Medicaid Services (CMS) has scheduled an important webinar on October 17, 2024, at 1:00 PM ET, specifically covering Section 111 reporting Civil Money Penalties (CMPs) and their implications for all relevant stakeholders involved in compliance and reporting.

Webinar Format and Focus From CMS

CMS will be hosting a comprehensive webinar regarding Certain Civil Money Penalties for NGHP Responsible Reporting Entities (RREs). This informative session aims to clarify the implications of these penalties and ensure that all RREs are well-informed. The format will include opening remarks from CMS officials, followed by a detailed presentation that will cover essential topics. Attendees can expect reminders about the Final Rule, insights into the auditing process, and critical dates that RREs need to remember. After the presentation, there will be a dedicated question-and-answer session, allowing participants to seek clarification and address specific concerns related to the Civil Money Penalties. This interactive component is designed to enhance understanding and foster engagement among all attendees.

RREs who would like to submit questions in advance of the webinar are encouraged to do so using the dedicated resource mailbox at Sec111CMP@cms.hhs.gov.

There is no pre-registration for the webinar.  Full details can be found here.

Previous Webinar Insights

The upcoming webinar focuses on Section 111 penalties, while a previous webinar covered Section 111 reporting best practices and upcoming changes. A copy of the slides and notes of the prior session are here.

CMS recently added a new page to its website, which provides NGHP Civil Money Penalties information, including a flow chart.  CMPs are applicable starting October 11, 2024, and audits begin in January 2026. We encourage a review of CMS’ website and articles Tower has published on the topic, including Section 111 Reporting for WCMSAs & Avoiding Civil Penalties.

Tower MSA Partners’ Chief Compliance Officer Dan Anders Featured on Ametros Podcast “It’s Settled”

September 25, 2024

Tower MSA Partners’ Chief Compliance Officer Dan Anders Featured On Ametros Podcast

Dan Anders, Chief Compliance Officer at Tower MSA Partners, was recently featured on Ametros’ podcast, “It’s Settled.

We are excited to share that Dan Anders, Chief Compliance Officer at Tower MSA Partners, was recently featured on Ametros’ podcast, “It’s Settled.” In this engaging episode, Dan sat down with Andrea Mills, Ametros’ Chief Client Officer, and John Kane, Senior Vice President of Strategy, to dive deep into the latest news and developments surrounding Medicare Set-Asides (MSAs). This discussion covered essential topics that impact the workers’ compensation and liability settlement space, including upcoming changes to Section 111 reporting, best practices for preparing MSAs, and the value of professional administration.

Upcoming Section 111 Reporting Changes

One of the key topics covered was the upcoming changes to Section 111 reporting and their implications for insurers and self-insured entities. Dan provided insightful commentary on what these changes mean and how they will affect the reporting process. With new compliance requirements on the horizon, now is the time for stakeholders to review their reporting strategies and ensure they are prepared for these regulatory shifts.

When to Prepare an MSA

Another critical topic discussed was when to prepare an MSA. Dan highlighted the importance of evaluating the need for an MSA early in the settlement process to avoid costly delays. He also provided insights into how Tower MSA Partners helps clients navigate complex cases by offering expert guidance on when and how to prepare MSAs effectively.

The Value of Professional Administration

The conversation also touched on the value of professional administration for MSAs, emphasizing how Ametros helps individuals manage their settlement funds to ensure compliance with Medicare’s requirements. Dan, Andrea, and John discussed how professional administration not only ensures the longevity of settlement funds but also helps alleviate the administrative burden on injured individuals.

Tips for Preparing an MSA

During the episode, Dan shared several tips and tricks for preparing an MSA, helping listeners understand the importance of accuracy and thoroughness when it comes to documentation. He also explained how Tower MSA Partners’ streamlined approach helps clients minimize risks and expedite settlements.

Upcoming Webinars and Conferences

As the discussion wrapped up, the group previewed upcoming educational opportunities, including a webinar, A Claims Professional’s Guide to Successful Settlements with MSAs, hosted by Tower MSA Partners on October 2nd. Dan encouraged attendees to sign up for this and other webinars to stay informed on compliance topics and best practices in the MSA industry.

Listen Now

You can catch this insightful episode of “It’s Settled” featuring Dan Anders by clicking here.

Stay tuned for more updates from Tower MSA Partners as we continue to provide our clients with the latest compliance and settlement strategies. Be sure to sign up for our upcoming October 2nd webinar to stay informed on these important issues.

CMS Moves Start Date for WCMSA Reporting to April 2025

April 23, 2024

CMS delays start date for section 111 reporting of WCMSAs

CMS delays start date for Section 111 reporting of WCMSAs to April 2025 and announces new webinar for Q&A

During last week’s webinar, the Centers for Medicare and Medicaid Services (CMS) announced an extension of the start date for Section 111 reporting of WCMSAs from January 2025 to April 4, 2025.

(Due to technical difficulties with the April 16 webcast, CMS has scheduled another webinar for Q&A this Thursday, April 25, 2024, at 2:30 ET. Details on the webinar are here.

Remember, CMS requires Section 111 reporting of WCMSAs of any MSA amount, even if $0. These amounts must be reported whether they are CMS-approved MSAs or not.

CMS details new reporting guidelines and start date for Section 111 WCMSA Implementation

CMS reiterated several points that had been detailed in a prior webinar and through the recent Section 111 User Guide update.  Please review CMS Updates Section 111 NGHP User Guide and WCMSA Reference Guide for this information. New points are below:

  • The start date for WCMSA reporting was changed from January 2025 to April 4, 2025, to give Responsible Reporting Entities (RREs) more time to make the needed changes to their reporting processes.
  • Testing of the new fields will be available beginning on October 7, 2024.
  • All WCMSA fields except Field 43 (Professional Administration EIN) will result in “hard” errors if reported incorrectly. Hard errors cause the TPOC report to be rejected, which can in turn cause the report to be untimely if it is not corrected promptly.
  • As such, hard errors may result in the imposition of civil money penalties (CMPs) although CMS will not impose a CMP for two reporting periods after implementation of WCMSA reporting. In other words, only records on or after October 15, 2025, and with a reportable MSA are subject to a CMP.
  • If an RRE fails to report an MSA, CMS may utilize all available statutory and regulatory options to recover mistakenly made payments, including under the False Claims Act.
  • No changes are made as to what constitutes a reportable TPOC. If a TPOC is reportable, then the WCMSA fields must be completed. If it is not reportable, such as when the WC settlement is $750 or less, then the WCMSA fields are not completed.
  • If multiple defendants are parties to a single settlement, they must report the total TPOC amount (and not their “share”) and the total MSA amount.
  • The Section 111 reporting process is not intended to replace the submission of settlement documents to CMS following the settlement of a claim with a CMS-approved MSA. (Final settlement documents should always be sent to Tower for upload to CMS.)
  • Receipt of the MSA report through the Section 111 reporting process will allow CMS to send information to the beneficiary on the attestation and exhaustion process. (Currently this is not done for most self-administered non-submit MSAs).

CMS outlines impact of “W” records in common working file (CWF) for MSA reporting

CMS also explained that once the MSA is reported, a “W” record will be posted in the Common Working File (CWF), which prevents payments of medical services related to the reported diagnosis codes. The CWF is part of CMS’s system to accurately coordinate benefits, so Medicare does not make payment when another “primary payer” is available.

A copy of the webinar slides can be found here.

Please contact Dan Anders at daniel.anders@towermsa.com with any questions.

CMS Sets April 16 for Webinar on Section 111 Reporting of WCMSAs

March 27, 2024

Webinar on Section 111 Reporting of WCMSAs

Prepare for Change: CMS Webinar on Expanding Section 111 NGHP TPOC Reporting to Include WCMSA Information

The Centers for Medicare and Medicaid Services has scheduled a webinar for April 16, 2024, at 2 PM ET to provide updates on the implementation of Section 111 reporting of Workers Compensation Medicare Set-Asides (WCMSAs).  Per the March 25, 2024 announcement:

CMS will be hosting a second webinar regarding the expansion of Section 111 Non-Group Health Plan (NGHP) Total Payment Obligation to Claimant (TPOC) reporting to include Workers’ Compensation Medicare Set-Aside (WCMSA) information. After the first webinar in November, CMS received additional questions and feedback from the industry. The intent of this webinar is to ensure that RREs will be prepared for the change once implemented. With that in mind, this webinar will include a background recap, summary of technical details, updated timelines and CMP impacts. The presentation will be followed by a question and answer session. Because this expansion impacts reporting of WCMSAs, it is strongly recommended that Responsible Reporting Entities (RREs) that report Workers’ Compensation settlements attend.

There is no pre-registration for the webinar.  Full details can be found here.

As of April 4, 2025, TPOC reporting must include Workers’ Compensation Medicare Set-Aside Arrangements (WCMSAs). (See CMS Sets Date for Start of Section 111 WCMSA Reporting).

The WCMSA reporting requirement applies to both CMS-approved and non-approved MSAs.  This information must be reported if the insurance type is workers’ compensation and the TPOC amount is greater than $0. The rule will be prospective only, meaning it applies to TPOC dates of April 4, 2025 and later.

To collect this data, CMS is adding new fields to the Section 111 Claim Input File.

Tower will provide a post-webinar summary.  If you have any questions, please contact Dan Anders at daniel.anders@towermsa.com or 888.331.4941.

 

Top 5 MSP Stories of 2023 & What to Expect in 2024

January 4, 2024

Top 5 MSP Stories of 2023 & What to Expect in 2024

As we start the new year, here’s a look at the top five Medicare Secondary Payer (MSP) compliance stories of 2023 and what to watch for in 2024.

 A Look Back

Centers for Medicare and Medicaid Section 111 Penalties Rule Released

The long-awaited Section 111 penalties rule was published in October. Surprisingly, the final rule was more narrowly focused than the proposed version. Now, only untimely reporting (defined as one year later than it should have been reported) of Ongoing Responsibility for Medicals (ORM) and Total Payment of Claim (TPOC) is at risk for potential penalties. Not only that, not all claims that run afoul of the rule will be penalized. CMS will incorporate a randomized selection process to identify records for audit. Finally, CMS’s rule only applies prospectively, that is, with reportable data on October 11, 2024, and later.

See CMS Section 111 Penalties Rule Focuses on Untimely Reporting and CMS Releases FAQs on Section 111 Penalties for more details.

CMS to Require Section 111 Reporting of WCMSA Amounts

In a November 16, 2023 webinar, CMS announced plans to require the report of a Workers’ Compensation Medicare Set-Aside (WCMSA) amount concurrently with the report of TPOC in Section 111 Mandatory Insurer Reporting.  While CMS can presently coordinate post-settlement Medicare benefits when they receive settlement documents with an MSA amount, except for CMS-approved MSAs, this is not required.

CMS wants to close this information gap with a requirement to disclose an MSA amount included in a workers’ compensation settlement whether CMS approved the MSA or not. In the webinar, CMS indicated it would like to have the new reporting fields in place by January 2025.  This represents a technical and training challenge for Responsible Reporting Entities (RREs), who will now have to capture and report this data along with the currently required information.

More information can be found in our article, CMS to Require Section 111 Reporting of WCMSA Amounts.

Amended Reviews Open to All MSAs

Tower had urged CMS for some time to drop the past 60-month time requirement for an Amended Review and open it up to any prior WCMSA determination. We were pleased when CMS ended the 60-month requirement in May. It now allows a one-time Amended Review when a case meets this criteria:

  • CMS has issued a conditional approval/approved amount at least 12 months prior.
  • The case has not yet been settled as of the date of the request for re-review.
  • Projected care has changed so much that the submitter’s new proposed amount would result in a 10% or $10,000 change (whichever is greater) in CMS’ previously approved amount.

Further information can be found in CMS Significantly Expands Amended Review MSA Availability and MSA Amended Reviews – Key to Settlements of Old Dog Legacy Claims

Option for Unsolicited Response File on ORM Record Changes

Starting in July 2023, RREs had the option to receive a monthly NGHP Unsolicited Response File through the Section 111 secure website. The Unsolicited Response File provides the RRE with changes made to ORM records by the Benefits Coordination and Recovery Center (BCRC), which were not requested by the RRE, but rather are typically in response to communication with the claimant. The file allows the RRE to update or correct its reporting dataor report to the BCRC that the action taken is inconsistent with the RRE’s legal obligations in relation to ORM.

See Section 7.5 of the NGHP Section 111 User Guide, Chapter IV, Technical Information, for further information on the NGHP Unsolicited Response File.

Medicare Conditional Payment Appeals Guide

While it did not break any new ground on bases to appeal Medicare conditional payments, the April release of the NGHP Applicable Plan Appeals Reference Guide represents an important move toward CMS transparency around demand letter appeals. The guide clarifies both the policy and process for RREs or their representatives in submitting such appeals. Notably, Tower referenced the guide in successfully appealing a Medicare conditional payment demand before a CMS Administrative Law Judge.

A copy of the guide can be found here.

What to Watch for in 2024

Section 111 Penalties Implementation:  As the data to be considered for Section 111 penalties is October 11, 2024 and later, there is no possibility of a penalty being issued in 2024 (as the data must be reported one year late). When it released the rules, CMS stated that it would have further policy announcements and webinars. This includes a January 18, 1:00 pm ET, informational webinar. Details on the webinar can be found here.

Section 111 Reporting of WCMSA Amounts: CMS has tentatively set the start date for reporting WCMSAs as January 2025. The planned timeframe is for an updated file layout and error codes to be released in early 2024, with testing in the fall of 2024. CMS is expected to issue written guidance along with webinars on the topic.

New MSPRP Portal Features:  CMS has indicated it will continue introducing new Medicare Secondary Recovery Portal features. We will be on the lookout for these throughout 2024.

Medicare Beneficiary Appeals Guide:  In 2023, CMS released an appeals guide for NGHP plans to appeal Medicare demands from the Commercial Repayment Center. We expect CMS will also release a similar document for Medicare beneficiaries to appeal demands from the BCRC.

Finally, there will surely be other CMS announcements during the year. As always, we will provide you with summaries and key takeaways.

Best wishes from your friends at Tower for a healthy, happy, and prosperous new year! Remember to contact our Chief Compliance Officer Dan Anders with questions about any MSP compliance and MSA issues. Reach him at daniel.anders@towermsa.com.