Gina Cox No Comments


Reducing cycle times, paid costs, and reserves is a top priority of nearly every leader in the personal injury insurance industry. These key metrics help determine the financial viability of a company and can be the determining factor for keeping employees.

However, optimizing the process for reporting and recovery of conditional payments for Medicare beneficiaries is often not a top priority. Here are three ways to improve this process and begin to save money and jobs.

Educate all Claims Processors

Claims involving a Medicare beneficiary can be highly complex. They come under strict regulatory guidelines that are constantly evolving and they must be reported and paid exactly as prescribed by the Center for Medicare and Medicaid Services (CMS) or they won’t be processed properly.

The complexity leads to Medicare-related personal injury claims taking an inordinate amount of time for the average claims handler to process to completion. Errors are common, requiring additional time and repeated effort.

Take the time to educate your claims processors so they feel comfortable with these specialized needs. You can start by making sure they know the types of personal injury claims Medicare recognizes.

Obviously, this level of education requires a huge investment in time and resources, not to mention many hidden costs, which is why many P&C Insurers turn to a Medicare compliance service provider like Flagship to handle these claims.

Review Claims Line by Line

In many cases, Medicare’s initial lien amount on a beneficiary’s claim is higher than the amount the insurer actually owes in reimbursement of Medicare’s conditional payment.

But, with pressure to reduce cycle times, claims adjusters are likely to happily write a check and close the file as soon as they receive the dollar amount Medicare is willing to accept.

That’s why Flagship Service Group assists its clients by taking the time to examine each Medicare claim to review line items that are actually the responsibility of the P&C insurer and which ones Medicare rightfully should pay. By eliminating all the charges not directly related to the injury being claimed, the overall cost of the reimbursement to Medicare – and therefore the total paid costs of the claim – can be reduced.

Maintain Realistic Reserves

When Medicare claims are not handled efficiently, insurers have a heavily inflated estimate of what a compliant closed Medicare-related claim will cost. This causes reserves established on historical costs to be unnecessarily high. The inflation of these claims may also artificially inflate estimates on other non-Medicare-related claims.

Once you have effectively reduced cycle times and paid costs on Medicare-related claims, make sure to re-evaluate your reserves based on new, realistic data.

Of course, having your Medicare claims processed by professionals who see them all the time and know them inside and out will also help you achieve the trifecta. Flagship offers just that. Learn more about understanding Medicare compliance.



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