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October 2011

CMS Combining the MSPRC & COBC; Appoints Interim MSPRC Contractor

The Centers for Medicare and Medicaid Services (CMS) have recently announced that they are combining the Medicare Secondary Payer Recovery Contractor (MSPRC) and the Coordination of Benefits Contractor (COBC) into a single entity called the Medicare Secondary payer Integration Contractor (MSPIC) for Medicare Set Asides. The significance of merging these two divisions according to CMS is to provide a single point of contact, improve debt and data collection, and enhance the customer service experience. As of October 1, 2011, the MSPRC work is now being performed by Group Health Incorporated (GHI) until the new MSPIC contract is awarded. Group Health Incorporated has been the COBC contractor for CMS since year 1999. CMS anticipates that the MSPIC contract will be awarded in late spring/early summer of year 2012.

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MMSEA Section 111 Mandatory Reporting Update

The Centers for Medicare & Medicaid Services (CMS) has recently published an (Optional delay) Alert Update relative to certain liability insurance (including self-insurance) TPOC settlements, judgments, awards, or other payments. CMS has not changed any other implementation dates. TPOCS Over $100K, TPOC Date On or After October 1, 2011, Reporting option January 1, 2012 TPOCS Over $50K, TPOC Date On or After April 1, 2012, Reporting option, July 1, 2012 TPOCS Over $25K, TPOC Date On or After July 1, 2012, Reporting option October 1, 2012 ALL TPOCS over min. threshold, TPOC Date On/After October 1, 2012, Reporting option, January 1, 2013. CMS again wishes to stress that the delay on reporting of these certain TPOCs is Optional. It important to note, that after full implementation of the Section 111 reporting requirements, CMS will use the normal notice of proposed rulemaking process for establishing any penalties.

What to Know About Final Demand Letters in Liability Insurance, Workers' Compensation Insurance, Self Insurance, & No Fault Claims

Did you know that Medicare issues Formal Demand Letters advising of the debtor his/her/its primary payment responsibility once a termination date applies to a case (generally the date of settlement, judgment, & or award. This Letter is issued by the Medicare Secondary Payer Recovery Contractor. If the debtor is an insurer or Workers Compensation carrier/Third Party Adminstrator that wishes to dispute its obligation to repay Medicare, and benefits have already been paid to the beneficiary or a provider/supplier, the insurer/carrier must provide an explanation of benefits or record of payment. Assessment of Interest and Failure to Respond Interest accrues from the date of the demand letter but is only assessed if the debt is not repaid or otherwise resolved within the time period specified in the recovery demand letter. Interest is due and payable for each full 30-day period the debt remains unresolved

Workers Compensation Review Contractor (WCRC) Contract Delayed Again

In response to the earlier bid protest to The U.S. Government Accountability Office (GAO) The Centers for Medicare and Medicaid Services (CMS) has again delayed contract execution for the new WCRC contract. CMS has issued a stop work order and are now re-evaluating all proposals from offers within the "competitive range." It is expected that their analysis will be completed by November 10, 2011. Please click on the related link below for more information. We will continue to monitor the situation closely and will provide updated information in future newsletters.

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The New Medicare Set-Aside Portal (WCMSAP) Likely to be Available Soon

Since approximately July of 2011, The Centers for Medicare & Medicaid Services (CMS) has been test piloting its Medicare Set Aside Portal. We will be monitoring the current backlog of cases to determine the processing efficiency of the new portal. As posted on CMS's own website, they anticipate that this new portal capability will greatly improve the efficiency of the submission process and will allow creation of a work-in-progress case, submission of WCMSA cases, performance of case lookups, and the ability to append documentation to a case. Blackburn Group, Inc. will be participating in this new CMS development that is expected to improve CMS Approvals.

CMS Begins Using The 2007 US Life Tables

The Centers for Disease Control (CDC) has recently published its 2007 United States Life Tables. Effective October 31, 2011, the Centers for Medicare and Medicaid Services (CMS) will begin referencing the CDC's Table 1: Life table for the total population: United States, 2007, for life expectancy calculations.

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