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Why YOU Should Be in Control of Your Medicare Compliance

There are two vital rules you need to follow when it comes to managing risk:

  1. Never trust a lawyer.
  2. See Rule #1, especially when that lawyer’s interests are averse to yours.

Tongue-in-cheek aside, these rules make sense from a business perspective.  Yet, when dealing with the matter of compliance to Medicare’s personal injury claims reporting and recovery guidelines, far too many insurance carriers routinely break these rules, often to their detriment.

As an insurance executive, you would never allow a claimant’s lawyer to come in and have free access to your claim data.  Not only are they not experts in the necessary skills to handle your money, they also have a significant conflict of interests: their goal is to get as much money for their client – and, by extension, themselves – as possible.  Read more

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Why the CEO and VP of Claims Should Care About Medicare Compliance

Statistically, Medicare-related claims make up around 10-15% of your total claims volume at any given time.

It doesn’t seem like much when you consider it in that light, so often busy insurance executives may fail to give Medicare compliance the emphasis it deserves.  Here are some important reasons why both the CEO and the VP of Claims should bring Medicare compliance up a notch or two in their list of priorities.

It’s a money issue, not just a compliance issue.

Unlike the other risks insurance executives are used to, Medicare compliance can have a direct impact on the company’s bottom line.

Penalties for non-compliance are strong, and are becoming more readily assessed through more stringent and more frequently ordered auditing procedures.  If the carrier is found to be non-compliant on a Medicare-related personal injury claim, fines can be as high as double the initial settlement amount, plus interest.

On higher-value claims, that kind of penalty can put a serious dent into annual financials. Read more

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Why You Shouldn’t Cherry-pick Your Biggest Claims for Medicare Compliance

We’re going to jump up on our soapbox for a moment here, so bear with us.

We’ve noticed a common trend among our competitors that just really rubs us the wrong way.  Many companies offering to handle Medicare compliance for P&C insurance carriers recommend focusing on the largest claims.  Insurance carriers may even think this strategy is the industry standard.

But it’s not.

What we’re talking about is cherry picking the largest claims for Medicare compliance review and closure and ignoring the rest.

Now, it’s obvious why so many companies go this route: it takes less time, it provides impressive-looking results for the client, and it rakes in high profits for the company handling the Medicare claims.  If you’re a smooth-enough talker, it can sound like a win-win for everyone involved.

But it’s NOT in the best interests of the insurance carriers.  Here’s why:

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How Flagship Services Group Helps Claims Adjusters – Part One

This is the first in a two-part blog series involving the day-to-day role of a claims adjuster at the average P&C insurance carrier and how Flagship Services Group can make that day easier and more rewarding.  In this post, we’ll look at some potential pitfalls the average claims adjuster is not going to want to deal with.  In the next post, we’ll discuss how these pitfalls are avoided.

The average claims adjuster at a mid-size to large P&C insurance carrier – let’s call him Bob – has myriad tasks to handle throughout a given day.

Bob’s Busy Day

Bob starts the day listening to 14 voicemails that came in since he left the previous day.  Three are from one particularly tenacious and obnoxious lawyer who enjoys trying to bully adjusters with crude language and a lot of bluff and bluster. The rest are from various claimants, attorneys, and other sources he’s been playing phone tag with for days now.

Next, over a cup of not-so-good coffee, Bob reviews his inbox to find two new files in his queue.  This puts his total case load at 134 – not the worst he’s seen, but right up there.  He sighs and pulls out a Post-It note to remind himself to make the obligatory contact call on each of these new claims before he leaves today since the 24-hour service standard will have expired before he gets in tomorrow.

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How Flagship Services Group Helps Claims Adjusters – Part Two

This is the second in a two-part blog series involving the day-to-day role of a claims adjuster at the average P&C insurance carrier and how Flagship Services Group can make that day easier and more rewarding.  In the last post, we looked at some potential pitfalls the average claims adjuster does not want to deal with.  In this post, we’ll discuss how these pitfalls are avoided.

As we noted in the previous post, the average claims adjuster at a mid-size to large P&C insurance carrier has a heavy case load and a lot of stringent requirements and KPIs keeping them on their toes. 

We were introduced to Bob, a P&C staff claims adjuster who just opened up a new file to find it’s one of those dreaded Medicare reimbursement cases.  The claimant is a Medicare beneficiary who was injured in a motor vehicle accident and was in the hospital for several days.  In addition, he has ongoing physical therapy and follow-up medical bills in the mix.  Medicare has already paid for the hospitalization and a Conditional Payment Letter is on its way.

Now, Bob only sees one or two of these types of claims every month, in among as many as 200 claims he may touch in that same amount of time.  As a result, he’s not completely comfortable with all the regulations involved, and he knows it’s going to take a lot of time to research it and get that all straight before he can proceed with confidence.  

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It’s Time for P&C Insurers to Learn Medicare’s Secondary Payer Rights

wc_annual-1The 23rd annual National Workers’ Compensation and Disability Conference was held on November 19-21, 2014.  The biggest event of its kind, this year’s conference enjoyed a record breaking attendance for the fifth year in a row.

On Thursday, November 20, at 8:30 am, a breakout session was held that really piqued our interest here at Flagship Services Group: Workers’ Compensation and its Secondary Payers: Medicare and Medicaid.  The presentation was led by Vernon Sumwalt and Tim Nay, both attorneys with years of experience in workers’ compensation (in Sumwalt’s case) and Medicare Second Payer Compliance (in Nay’s case.)  The discussion was moderated by Jennifer C. Jordan of MEDVAL, LLC., a nationally recognized expert in Medicare compliance.

The key takeaway from the discussion had to do with the new laws that have been enacted by Congress, and are set to go into effect in October of 2016, which will essentially make Medicaid very similar to Medicare in both the reporting and recovery aspects of its role as secondary payer.

While the discussion centered primarily around how this affects workers’ compensation claims, the same principles apply equally well to the personal injury side of the picture that we specialize in.  

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Flagship Welcomes Harrison Ryder as Vice President of Sales

Harrison_Ryder_11_(133x200)We’re thrilled to have a new member of the executive team joining us this month: R. Harrison Ryder, III, our new Vice President of Sales.
Harrison comes to us with a wealth of knowledge and experience in sales that spans many different industries and disciplines, including legal, IT, management consulting, and healthcare.  The bulk of his career experience, including well over $50 million in aggregate sales, has been in working with C-level executives using a consultative sales approach that meshes beautifully with how Flagship Services Group approaches selling our own services.
“What drew me to Flagship was the opportunity to work with a group of bright and talented individuals in a growth market, and for a young company that is positioned to capture significant market share,” said Harrison.
Most recently, Harrison served as Vice President of Sales at the David Corporation, a California-based provider of risk management software solutions to the alternative risk and specialty P&C markets. He’s well versed in the compliance side of our target market, and knows how to relate directly to the decision makers in P&C insurance companies that can benefit most from what Flagship has to offer.

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Need to Resolve a Medicare Lien? Start With These 3 Steps

medicare compliance

Resolving a Medicare lien can be costlier and more time consuming than most other claims of similar value and complexity. Part of the reason for this is the relative rarity with which your claims adjusters process these claims. Part of it comes from the fact that Medicare regulations are constantly evolving. And, of course, the intricacies of properly reporting and filing these claims simply take a long time to complete.

We’ve established a simple, three step process for effectively resolving Medicare liens – and really, handling all Medicare compliance issues your company is faced with – quickly and efficiently.

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3 Reasons to Hire a Medicare Compliance Service Provider

Laptop Work-2

Maintaining compliance with Medicare rules and regulations can be compared to marketing a small business: you could do it yourself, and you might have some success, but if you hire a professional, you’ll have more time, better results, and your savings will be significantly higher.

The hidden internal costs of DIY compliance

As a P&C insurance organization, your company employs dozens – perhaps hundreds – of claims adjusters who deal with a huge volume of claims over the course of a month. Only about 17% of those claims involve Medicare beneficiaries and only a portion of those claims fit the requirements for Section 111 reporting and repayment of conditional payments. Read more