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03/Jun/2025

CMS will be hosting an Introduction to WCMSAs Webinar. The intent of this webinar is to go over the basics of WCMSAs including purpose, submission guidelines and administration as well as to offer some WCMSA best practices. The presentation will be followed by a question-and-answer session. As this Webinar is intended to provide a general overview of the WCMSA process, questions regarding specific cases are not appropriate for this setting. Those involved in the submission and administration of WCMSAs, including attorneys and Medicare beneficiaries, are encouraged to attend.


 

Date: June 17, 2025
Time: 2:00 PM ET

Webinar Link:  https://cms.zoomgov.com/j/1605891582?pwd=7NeMcu0ezDDwYCCRiezZMY2MLiXY0d.1
Passcode: 922100

Or to connect via phone:

Conference Dial In: 1-833-568-8864
Conference Passcode: 160 589 1582

Important Note: This is a public webinar, and there is no pre-registration. The link above will not be active until the day of the webinar.


 

Additional information about the most recent updates from CMS can be found here. If you have questions on how topics discussed in this webinar may affect your clients or your company, please contact Medivest or call us at 877.725.2467.

 


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Effective July 1, 2009, the Medicare & Medicaid SCHIP Extension Act (MMSEA) requires that “applicable plans” must first determine whether an injured party (including an individual whose claim is unresolved) is entitled to Medicare benefits. The primary payer must then report the “required information,” once the case is resolved, to the Secretary of the Department of Health and Human Services (Secretary of HHS) in the “form, manner, and frequency” the Secretary prescribes (CMS is a regulatory body under HHS). If this information is not provided to Medicare in the form, manner, and frequency requested, Medicare may impose a fine of up to $1000 per day, per injured party, as Civil Monetary Penalties (CMPs).

Before the MMSEA was enacted, Medicare relied on settling parties to notify it when settling a case for a Medicare beneficiary. This process allowed Medicare to gather some information about the case and look for instances where it had made payments for treatment and RXs where there was a primary payor involved (i.e. Carrier, TPA, Self-Insured, etc). Because this information was not required by law, Medicare put in place a mandatory insurer reporting (MIR) process that requires primary payors to provide over 200 data fields with information about the case and all the parties involved. The collection of that data is then used to place a marker in Medicare’s system. This marker will help Medicare determine if treatment or prescriptions are related to a settlement involving a primary payor. Medicare will then use that marker as a reference point to deny paying for Medicare-covered, case-related treatment. There have been improvements made to the system over the last 16 years, and the number of data fields that must be reported has increased over time.

Fast forward to April 4th, 2025. Medicare now requires that if a MSA allocation was prepared on the case, that information must be entered into the WCMSA field during the reporting process. Medicare expects the MSA amount to be spent on Medicare-covered, case-related treatment per CMS’s guidelines for MSA funds. In the past, Medicare was unaware of the MSA amount if the case was not submitted to CMS for approval. CMS has seen a steady decline in cases being submitted for approval, and essentially had no viewership on the MSA figure, which makes it difficult to know when Medicare would step in and become the primary payor again for Medicare-covered, case-related items. As of April 4th, 2025, Medicare now requires this information to be provided to them for WC settlements, regardless of whether a MSA allocation was submitted to them for approval.

Medicare is now armed with all the information they need, regardless of submission status, to review and deny payments for Medicare-covered, case-related items. This will force the individual to use those MSA funds for Medicare-covered, case-related treatment until they are exhausted. Accurate accounting and annual attestations (post-settlement) must be provided to Medicare before they step in as the primary payor. If the beneficiary fails to provide the necessary information, Medicare will continue to deny payments until proper documentation is provided that shows the WCMSA funds were spent in compliance with Medicare guidelines. If those funds were misappropriated, Medicare will continue to deny payment for any Medicare-covered, case-related treatment and RXs until the funds are replenished and spent according to Medicare’s guidelines.

In 2017, CMS indicated, “Although beneficiaries may act as their own administrators, it is highly recommended that settlement recipients consider the use of a professional administrator for their funds.” Now that the WCMSA field is required as part of the Mandatory Insurer Reporting process, it is critical to discuss the proper administration of the MSA funds during the settlement process.

If you have any questions or would like more information about how Medivest can protect future Medicare benefits for the injured worker, please contact us at info@medivest.com or contact our office at 877-725-2467.

 


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08/Apr/2025

On April 7, 2025, the Centers for Medicare & Medicaid Services (CMS) updated the MMSEA Section 111 NGHP User Guide to version 8.0. The newer version has been posted to the NGHP User Guide page, found here. The NGHP User Guide to version 8.0 replaces Version 7.9 which was released on January 17, 2025.

MMSEA III – April 7, 2025 – NGHP User Guide version 8.0 Downloads

Chapter 1: Introduction and Overview

The updates listed below have been made to the Introduction and Overview Chapter Version 8.0 of the NGHP User Guide. As indicated on prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary. There are no changes for this version.

Chapter II: Registration Procedures

The update below has been made to the Registration Procedures Chapter Version 8.0 of the NGHP User Guide. As indicated in prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary. To align with new WCMSA reporting requirements effective April 4, 2025, field numbers have been updated throughout this guide.

Chapter III: Policy Guidance

The updates listed below have been made to the Policy Guidance Chapter Version 8.0 of the NGHP User Guide. As indicated in prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary. To align with new WCMSA reporting requirements effective April 4, 2025, field numbers have been updated throughout this guide.

Chapter IV: Technical Information

The updates listed below have been made to the Technical Information Chapter Version 8.0 of the NGHP User Guide. As indicated in prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide, as necessary. A clarification has been added that the reporting threshold does apply to non-trauma no-fault and workers’ compensation cases (Section 6.4). The Event Table has been updated to include three new scenarios involving MSA corrections (Section 6.6.4). To align with new WCMSA reporting requirements effective April 4, 2025, field numbers have been updated throughout this guide.

Chapter V: Appendices

The updates listed below have been made to the Appendices Chapter Version 8.0 of the NGHP User Guide. As indicated in prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary. To align with new WCMSA reporting requirements effective April 4, 2025, field numbers have been updated throughout this guide. To reflect improved reporting requirements, Zip+4 section guidance has been updated (Appendix A, Appendix B, and Appendix G). To ensure consistency of data, as of October 6, 2025, the Recovery Agent TIN field is required if agent name is submitted (Appendix B and Appendix G).

270/271 Health Care Eligibility Benefit Inquiry and Response Companion Guide for Mandatory Reporting Non-GHP Entities Version 6.0

The email address for contacting an Electronic Data Interchange (EDI) Representative has changed to COBVA@bcrcgdit.com. However, COBVA emails coming from CMS now show the address as COBVA@mail.cms.hhs.gov (Customer Support).

For Additional Information

Medivest will continue to monitor changes occurring at CMS and will keep its readers up to date when such changes are announced. For questions, feel free to reach out to the Medivest representative in your area by clicking here or call us direct at 877.725.2467.

 


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08/Apr/2025

Centers for Medicare & Medicaid Services (CMS) has revised the WCMSA Reference Guide to reflect recent changes in CMS policy and Section 111 reporting requirements. Version 4.3, dated April 7, 2025 has three notable changes:

1) A Notice of Settlement Received letter has been added to the Guide at Appendix 5 to support the new Mandatory Workers’ Compensation Medicare Set-Aside (WMSA) reporting requirements;

2) The one year waiting period for the Amended Review of MSAs has been removed from Section 16.3; and

3) The revised Reference Guide provides additional clarity around CMS’ change of MSA submitter policies (Sections 16.3 and 19.4).

For Additional Information

Medivest will continue to monitor changes occurring at CMS and will keep its readers up to date when such changes are announced. For questions, feel free to reach out to the Medivest representative in your area by clicking here or call us direct at 877.725.2467.


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07/Apr/2025

The Centers for Medicare & Medicaid Services (CMS) has released the Self-Administration Toolkit for WCMSAs version 1.7 on April 7, 2025. The Toolkit replaces Version 1.6, which was released on August 1, 2024. 

To download the new Self-Administration Toolkit for WCMSA Version 1.7 click here.

Self-Administration with Additional Help

For injured parties who are considering self-administration, but also want additional consultation on the process, Medivest provides a Self-Administration Kit. With the purchase of the Medivest Medicare Set-Aside Self-Administration Kit, the injured party will receive a one-hour consultation on the proper administration of a Medicare Set-Aside account, covering topics including: 

  • Where to deposit and hold Medicare Set-aside funds 
  • Which expenses are allowed to be paid from a Medicare Set-Aside account 
  • What rates must be used to negotiate and pay expenses 
  • How to annually report the Medicare Set-aside to the CMS 
  • What to do if the MSA funds exhaust temporarily or permanently 
  • How to discuss a Medicare set-aside with a medical provider 
  • What are the tax implications of interest earned on Medicare Set-Aside funds 

 

For Additional Information

Medivest will continue to monitor changes occurring at CMS and keep its readers updated when such changes are announced. For questions about self-administration, professional administration or anything else regarding rules and recommendations from CMS, feel free to contact the Medivest representative in your area by clicking hereor calling us at 877.725.2467. 

 


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06/Mar/2025

CMS will be hosting an Introduction to MSP for Beneficiary Representatives webinar. The intent of this webinar is to support the attorney and beneficiary representative communities and review the basics of MSP, Group Health vs. Non-Group Health Coordination of Benefits, and MSP recovery. The presentation will be followed by a question-and-answer session.


 

Date: March 27, 2025
Time: 1:00 PM ET

Webinar Link: https://cms.zoomgov.com/j/1602933030?pwd=CS3jdG0Whh8BcACklF4Dwi3OU9zuCc.1
Passcode: 082211

Or to connect via phone:

Conference Dial In: 1-833-568-8864
Conference Passcode: 160 293 3030

Important Note: This is a public webinar and there is no pre-registration. The link above will not be active until the day of the webinar.


 

Additional information about the most recent updates from CMS can be found here. If you have questions on how topics discussed in this webinar may affect your clients or your company, please contact Medivest or call us at 877.725.2467.


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07/Jan/2025

On January 6, 2025, the Centers for Medicare & Medicaid Services (CMS) updated the MMSEA Section 111 NGHP User Guide to version 7.9. The newer version has been posted to the NGHP User Guide page, found here. The NGHP User Guide to version 7.9 replaces Version 7.8 which was released on December 6, 2024.

MMSEA III – January 6, 2025 – NGHP User Guide version 7.9 Downloads

Chapter 1: Introduction and Overview

The updates listed below have been made to the Introduction and Overview Chapter Version 7.9 of the NGHP User Guide. As indicated on prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary. There are no changes for this version.

Chapter II: Registration Procedures

The update listed below has been made to the Registration Procedures Chapter Version 7.9 of the NGHP User Guide. As indicated on prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary. There are no changes for this version.

Chapter III: Policy Guidance

The updates listed below have been made to the Policy Guidance Chapter Version 7.9 of the NGHP User Guide. As indicated on prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary. As of January 1, 2025, the threshold for physical trauma-based liability insurance settlements will remain at $750. CMS will maintain the $750 threshold for no-fault insurance and workers’ compensation settlements, where the no-fault insurer or workers’ compensation entity does not otherwise have ongoing responsibility for medicals (Section 6.4).

Chapter IV: Technical Information

The updates listed below have been made to the Technical Information Chapter Version 7.9 of the NGHP User Guide. As indicated on prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide, as necessary. As of January 1, 2025, the threshold for physical trauma-based liability insurance settlements will remain at $750. CMS will maintain the $750 threshold for no-fault insurance and workers’ compensation settlements, where the no-fault insurer or workers’ compensation entity does not otherwise have ongoing responsibility for medicals (Section 6.4).

Chapter V: Appendices

The updates listed below have been made to the Appendices Chapter Version 7.9 of the NGHP User Guide. As indicated on prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary. There are no changes for this version.

270/271 Health Care Eligibility Benefit Inquiry and Response Companion Guide for Mandatory Reporting Non-GHP Entities Version 6.0

The email address for contacting an Electronic Data Interchange (EDI) Representative has changed to COBVA@bcrcgdit.com. However, COBVA emails coming from CMS now show the address as COBVA@mail.cms.hhs.gov (Customer Support).

For Additional Information

Medivest will continue to monitor changes occurring at CMS and will keep its readers up to date when such changes are announced. For questions, feel free to reach out to the Medivest representative in your area by clicking here or call us direct at 877.725.2467.

 


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17/Dec/2024

On December 16th, Centers for Medicare & Medicaid Services (CMS) announced that 2025 recovery thresholds for physical trauma liability, no-fault and Workers’ Compensation settlements, judgments, awards or other payments by CMS (Settlements) will remain at $750. The full announcement can be read here.

This threshold does not apply to ingestion, implantation or exposure Settlements. The $750 threshold will continue to apply to Workers’ Compensation and no-fault insurance settlements as long as the entities do not have ongoing responsibility for medicals.  As usual, there is no Section 111 reporting requirement for Settlements under $750, and CMS will not seek recovery for conditional payments/Medicare liens arising from below threshold Settlements.

Additional information regarding the methodology used to determine the threshold has been provided here.

For Additional Information

Medivest will continue to monitor news and updates from CMS, and will keep its readers up to date when important announcements are made. For questions about this chart or any other recent updates, feel free to reach out to the Medivest representative in your area by clicking here or call us direct at 877.725.2467.


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11/Dec/2024

On December 6, 2024, the Centers for Medicare & Medicaid Services (CMS) updated the MMSEA Section 111 NGHP User Guide to version 7.8. It has been posted to the NGHP User Guide page, found here. The NGHP User Guide to version 7.8 replaces Version 7.7 which was released on October 7, 2024.

MMSEA III – December 6, 2024 – NGHP User Guide Downloads 7.8

Chapter 1: Introduction and Overview

The updates listed below have been made to the Introduction and Overview Chapter Version 7.8 of the NGHP User Guide. As indicated on prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary. There are no changes for this version.

Chapter II: Registration Procedures

The update listed below has been made to the Registration Procedures Chapter Version 7.8 of the NGHP User Guide. As indicated on prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary. There are no changes for this version.

Chapter III: Policy Guidance

The updates listed below have been made to the Policy Guidance Chapter Version 7.8 of the NGHP User Guide. As indicated on prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary. A new section has been added that discusses Workers’ Compensation Medicare Set-Aside Arrangements (WCMSAs), within the workers’ compensation TPOCs section (Section 6.4.4).

Chapter IV: Technical Information

The updates listed below have been made to the Technical Information Chapter Version 7.8 of the NGHP User Guide. As indicated on prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide, as necessary. A new section has been added that discusses Workers’ Compensation Medicare Set-Aside Arrangements (WCMSAs), within the workers’ compensation TPOCs section (Section 6.4.4.1).

Chapter V: Appendices

The updates listed below have been made to the Appendices Chapter Version 7.8 of the NGHP User Guide. As indicated on prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary. There are no changes for this version.

270/271 Health Care Eligibility Benefit Inquiry and Response Companion Guide for Mandatory Reporting Non-GHP Entities Version 6.0

The email address for contacting an Electronic Data Interchange (EDI) Representative has changed to COBVA@bcrcgdit.com. However, COBVA emails coming from CMS now show the address as COBVA@mail.cms.hhs.gov (Customer Support).

 

For Additional Information

Medivest will continue to monitor changes occurring at CMS and will keep its readers up to date when such changes are announced. For questions, feel free to reach out to the Medivest representative in your area by clicking here or call us direct at 877.725.2467.

 


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05/Dec/2024

On November 26th, 2024, the Centers for Medicare & Medicaid Services (CMS) shared a new report titled Workers’ Compensation Medicare Set-Aside (WCMSA) Fiscal Year Statistics 2024. The report provides five fiscal years of data regarding Workers’ Compensation Medicare Set-Aside (WCMSA) Proposed Value and Workers’ Compensation Review Contractor Values (WCRC) from 2020 to 2024.


Analysis

There was a 5.6% decrease in the number of WCMSA allocation reports that were submitted to CMS for review from 15,743 in Fiscal Year (FY) 2023 to 14,862 in FY 2024. There was also a drop in average settlement value of 4.7% from an average of $159,976.93 in FY 2023 to only $152,487.15 in FY 2024.

Despite this drop in settlement values, the WCMSA proposals for allocation reports submitted to CMS remained relatively flat, only dropping less than 2/10ths of one percent from $70,887.33 in FY 2023 to $70,775.58 in FY 2024. Counterhighers from CMS, correspondingly remained relatively flat moving from its published increase between the submitted versus recommended amount of 22% in FY 2023 to an increase of 21% in FY 2024.

The biggest change in the WCMSA CMS review statistics in recent years is that in 2022, when Section 4.3 was first added to the Reference Guide, the average counterhigher jumped from a 13-15% increase for FY 2020-2022 to what may be a “new era” for the last two years being between a 21-22% increase. Taking the average of 14% from FY 2020 – FY 2022 to the average of a 21.5% counterhigher increase for FY 2023 – FY 2024, this amounts to 31% increase in the counterhigher percentages!

Proposed MSAs and Total Settlement Amounts

Pre-CMS review WCMSAs constituted around 46% of the total settlement amount in FY 2024 up from 44% in FY 2023.

Medical vs Rx

Medical items and services represented approximately 79.3 % of the approved MSA amounts, whereas Rx represented 20.7% of the approved WCMSA amounts in FY 2024. The medical portion was 76.9% in FY 2023 with Rx accounting for 23.04% of the MSA in FY 2023. In FY 2020 by contrast, the medical portion was 68.6% and Rx expenses represented 31.4% of approved WCMSA amounts. Rx expenses have declined by 34% since FY 2020 as a percentage of the WCMSA . While several factors are likely to be at play here, CMS’ use of sometimes aggressive NDCs to price drugs may be one culprit. Medivest consistently sees submitted MSAs priced using drug NDCs unavailable in the actual market, and well below market average.

Take Aways

While reviews by CMS could in theory include acceptances or even reductions in the amount proposed by submitters as counterlowers, those who submit WCMSA’s have come to know that CMS reviews of WCMSA’s most often come back in the form of a counterhigher. It is important to distinguish a counterhigher from the term counter offer used in contract negotiations. While the WCMSA submission process is entirely voluntary, CMS’s Workers’ Compensation Medicare Set-Aside Arrangement Reference Guide (WCMSA Reference Guide) language and CMS operations consider the CMS review/approval response to be CMS’ final position on the acceptable amount to be set aside to protect Medicare’s future interests in the settlement, unless there is a successful Re-Review (allowed only for instances where there is a math error or the discovery of a document in existence prior to the time of submission but not included in the submission which is then allowed to be provided for the once only Re-Review opportunity). As a result, many in the industry say CMS uses the counterhigher to “voluntell” the parties the amount required to be set aside from their settlement for their WCMSA amount and that if an alternate amount is set aside or no amount is set aside, injury related medicals otherwise covered by Medicare could be denied by Medicare up to the settlement amount minus procurement costs instead of up to the CMS approval amount.

As background, total WCMSA submissions to CMS declined steadily between CMS’ FY 2020 and FY 2022, descending from 16,517 to 13,752, a reduction of almost 17% in three years. FY 2023’s 15,743 submission count seemed to have been a reversal of that trend until the 14,862 number for FY 2024 was reported. This seems to be the market shaking out the initial scare from Section 4.3. in which CMS had for the first time discussed “non-submit” or “evidence-based” MSA allocation reports as potential attempts to shift the burden of payment for injury related Medicare covered medicals to Medicare.

Proposed vs Recommended

While one can understand that CMS wants to protect the Medicare Trust Funds for both Medicare Part A and Part B, it does not seem to be productive for CMS to unfairly punish those who decide to voluntarily submit MSA’s in accordance with CMS WCMSA Reference Guide methodology. The statistics described above show that while the settlements have come down recently, the amount of the submitted WCMSA’s have not, so it’s not as if submitters have been lowballing their submissions. Those carriers who embraced a non-submit program in recent years to avoid higher WCMSA amounts associated with large counterhighers from CMS, may have not yet seen enough consequences to encourage a large return to voluntary submission practices.

The Big Question

These are statistics from those WCMSA’s submitted for approval, meaning they were written by industry-trained professionals in an attempt to match CMS’ recommended methodology. If the industry for those who submit have been consistent, but there has still been an increase in the counterhigher percentages, what has changed at CMS? While the fear in the stakeholder industry used to be focused on financial recovery by CMS under the Medicare Secondary Payer Act (MSP), could it be that CMS’s position concerning non-submitted WCMSA’s is evolving in the form of future Medicare denials for injured claimants who will be left to their own devices to attempt administrative appeals over those denials? The discussions of Section 4.3 of the WCMSA Reference Guide may have just the start of the new era, while CMS continues to build out its computer system in the background. Now, we are aware that there are new Section 111 Reporting requirements include the reporting of WCMSA amounts for all TPOC settlements involving current Medicare beneficiaries whether the WCMSA was submitted to CMS for review or not. Furthermore, the new Civil Monetary Penalty enforcement for untimely Section 111 reporting of ORM and TPOC applicable as of October of this year to be audited in October of 2025 seem to be clear additional steps of the new era, with additional data for CMS to continue to expand Medicare medical and Rx denials in the future. Routine reviews of business practices are prudent in any industry and as we head into another fiscal year, it is a great time to review your business practices to confirm your firm or company is taking the steps to help ensure best in class compliance standards that align with your clients’ interests and risk tolerances.

For Additional Information

Medivest will continue to monitor changes occurring at CMS and will keep its readers up to date when such changes are announced. For questions, feel free to reach out to the Medivest representative in your area by clicking here or calling us directly at 877.725.2467.

 


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