Medicare Conditional Payment Management
A Conditional Payment (CP) occurs when Medicare has paid for health care services provided to a Medicare beneficiary, but a primary payer exists who is responsible for those payments.
Medicare makes such payments on condition that reimbursement will be made to Medicare if the primary payer provides any compensation to the Medicare beneficiary (i.e. settlement, judgment, award, other).
Flagship saves P&C insurers millions of dollars annually in Medicare reimbursements by reducing the aggregate Conditional Payment Demand amounts.
- Flagship removes the Medicare headache from adjusters’ desks so they don’t have to be experts in the world of ever-changing Medicare regulations.
- Flagship enables claim adjusters to spend their time doing what they do best, closing the 85%-90% of claims that are non-Medicare related.
As a Conditional Payment Company we offer 100% Medicare Compliance
- End-to-End Solutions
- Mitigation of Medicare penalties by resolving all Conditional Payment liabilities.
- Protection of client’s financial resources by reducing Conditional Payment reimbursement amounts to the lowest defensible amount…and not a penny more!
- Simplification of Medicare compliance for claim adjusters by reducing their Medicare duties to a couple of basic steps – transmission of Medicare claims to Flagship at the front end, then filing Medicare closure documents at the back end.
- Management Reports
- Monthly Management Report that includes claim referral volume, Conditional Payment demands, fees, net savings, and ROI. Report, tracked by claim adjuster, can also be expanded to include individual claim offices and regional results.
- 100% Compliance guarantee when all Medicare and Flagship policies and procedures are followed.
- Louisiana Appellate Court Rules CMS Approval of MSA Was a Suspensive Condition that Suspended Obligation to Fund the MSA Until CMS Approval (5/21/2018) - Rafael Gonzalez, Esq. President, Flagship Services Group On May 2, 2018, the Third Circuit Court of Appeal of Louisiana published its opinion on Mary Ortega v. Cantu Services, Inc., concluding that the settlement of the workers compensation claim at hand was conditioned on CMS approval of a Medicare Set-Aside. Because the settlement agreement did not […]
- 6th Circuit Denies Beneficiary MSP Double Damages for Not Alleging Personal Financial Loss and Therefore Not Establishing Standing (5/15/2018) - On April 16, 2018, the United States Sixth Circuit Court of Appeals published its opinion on Gucwa and Marusza v. Lawley, Ager, Baker, Rubin and Accident Fund Insurance Company, finding that because Gucwa and Marusza did not allege personal financial loss in the original complaint or the two amended complaints, they have not established standing […]
- A Tale of Two Courts: Can MAPs Recoup MSP Double Damages from Medical Providers That Have Received Payment from Primary Payer? (4/23/2018) - Rafael Gonzalez, Esq. President, Flagship Services Group What a difference a couple of miles and a couple of days make. On March 2, 2018, the United States District Court for the Middle District of Florida, (Orlando), published its opinion on MSPA Claims 1, LLC v. Halifax Health, Inc., in which the court found that a […]