Amidst the NPRM chatter on Medicare Set Asides (MSA), with an October action date in the horizon, this is an opportune moment to calmly deliberate on key indicators.Read more
Key moments, thus far, to review and consider on the 2019 Medicare Secondary Payer voyage. Medicare Secondary Payer compliance can be complex with many changes to track from different and connected sources which affect administrative policies, procedures and processes. Flagship’s educational solutions are thoughtfully designed to explain matters in simple terms which help your team be informed and equipped to seriously chart an easier and safer compliance course.
August 5, 2019
Valued Flagship Clients,
Flagship Services Group, is pleased to announce that Robert J. Finley will serve as our Chief Legal Consultant. We are excited to work with Mr. Finley, who brings both knowledge and practical experience in Medicare Secondary Payer (MSP) compliance and regulation, as well as Medicaid third party liability and reimbursement matters.
Auto, liability, no-fault, and work comp primary payers- if you didn’t take Medicare and Medicaid secondary payer issues seriously before, here are over 2 million reasons why you should.
On November 14, 2017, the United States of America, the State of New Jersey, Progressive Garden State Insurance Company, Progressive Casualty Insurance Company, and Relator Elizabeth Negron entered into a settlement agreement for $2,392,700 on a False Claims Act matter in which certain Progressive automobile insurance policies caused health care providers to submit medical claims to Medicare and Medicaid in violation of secondary payer laws.
Rafael Gonzalez, Esq. President, Flagship Services Group
As Required by Section 1893(h) of the Social Security Act, the United States Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Medicare Secondary Payer (MSP) Commercial Repayment Center (CRC) published its third annual report to Congress for FY 2017 in March 2018. https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Coordination-of-Benefits-and-Recovery-Overview/Downloads/The-Medicare-Secondary-Payer-Commercial-Repayment-Center-in-Fiscal-Year-2017.pdf. Based on the Group Health Plan (GHP) and Non-Group Health Plan (NGHP) recovery work of the CRC, for FY 2017 (October 1, 2016 through September 30, 2017), CMS returned $131.78 million dollars to the Medicare Trust Funds.
It has been a long time coming, two years to be exact. After the Centers for Medicare and Medicaid Services (CMS) announced their anticipated release of a solicitation for the Workers’ Compensation Review Contractor (WCRC) in 2016 and 2017 and further announced it was continuing to consider expanding its voluntary MSA review process to include liability insurance (including self-insurance) and no-fault insurance MSA amounts in 2016 and 2017, Medicare Secondary Payer (MSP) stakeholders never thought the day would come. But, after a challenge of the awarded contract and after several months during which Provider Resources continued to work under an expired contract, on March 7, 2018, CMS finally held the WCRC Transition Webinar to introduce Capitol Bridge, LLC, the new workers’ compensation review contractor.
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.
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.
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:
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