Gina Cox No Comments

BenFranklinThe following is excerpted from the valuable white paper, “Distinguishable But Inseparable: Your Responsibility to Medicare and Why You’re Probably Doing it Wrong.” Get the full white paper by clicking below.

As Ben Franklin noted, nothing is certain but death and taxes.

We all realize the need to report taxes. Regardless of how much effort we put into reducing the total owed, reporting taxes accurately just makes good sense. The IRS is strong, savvy, and has a very long memory. Smart people report their taxes faithfully every year like clockwork.

But what if that’s all you did? What if you just handed in a tax return before April 15th admitting you owe Uncle Sam $1,000 in taxes for the year, but never actually wrote a check or mailed it in to pay that $1,000? How long could you get away with that?

Not very long.

It seems ridiculous to report what you owe to the government and then do nothing about paying it. It’s like giving the government perfect ammunition to fine you. After admitting that you know what you owe and signing the bottom line, what excuse could you possibly use to justify failing to pay?

As ridiculous as this sounds, many P&C insurance carriers take this exact approach when it comes reimbursing Medicare – who in this case is like their Uncle Sam. They fulfill their obligation to report a claim under Section 111, but completely skip the other half of the equation: reimbursing Medicare.

Reporting vs. Recovery

Medicare wants to collect what is owed to them. The largest pool of money for these collections is in outstanding reimbursements from Conditional Payments.

Now that Medicare has two laws to support payback, it intends to enforce them both. The reason Medicare introduced Section 111 Reporting was to facilitate MSP Recovery efforts. In other words, compliance with reporting obligations does not equate to compliance with recovery obligations, and vice versa.

Even though the rules governing Reporting and Recovery are different, they are inseparably related.


The real key to achieving 100% compliance with Medicare’s confusing and complex list of rules is to comply with both sides of the equation simultaneously. Doing so requires that you’re intimately familiar with a host of tasks required by both ends of the Medicare claims process, you’re willing to keep up with changes as Medicare decides to make them, and your claims team is willing and able to stay up to date as well.

Of course, another excellent alternative is to partner with a company that provides Medicare compliance services all day, every day. Flagship protects your financial resources by reducing risk.

For more information on complying with reporting and recovery requirements, read the full white paper below.


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