Medicare Conditional Payments Resolution Compliance Program Delivers 328% ROI
It is undeniable. Medicare Secondary Payer (MSP) issues have become more and more complex over the last 25 years. They have also made handling liability, no‐fault, and work comp claims more and more difficult and costly. These are the reasons why Flagship Services Group came to exist.
Flagship assists liability, no‐fault, and work comp payers to navigate MSP situations, providing insurers, self‐insureds, and third party administrators specifically tailored services and products to successfully process all components of MSP compliance, especially resolution of conditional payments. Medicare compliance for property and casualty insurers, third party administrators, and self‐insureds is our sole focus.
We are experts in conditional payments resolution. It is what we do every day, all the time, on every case. Based on our years of experience resolving thousands of conditional payment claims, we have created our very own lien resolution process, built a one of a kind claims processing system, and put together the most amazing, dedicated and talented staff of claims specialists, and medical and legal professionals with years of experience handling Medicare and Medicaid conditional payments.
What follows are results from our 2017 annual study of the last 12,744 liability, no‐fault, and work comp conditional payment claims that we processed, resolved, completed, and closed. Our study shows Flagship was able to:
- Find a reduction in over 50% of all the liability, no‐fault, and work comp claims it handled
- Reduce Medicare’s request for reimbursement by 67%
- Deliver a total of $27.6 million in savings, and average of over $4,000 in savings per claim.
- Provide clients with over 325% return on investment based on the ratio of fees to savings.
Over 12,744 liability, no‐fault, and work comp conditional payment cases have been processed, resolved, completed and closed.
We handle all types of claims. Of the 12,744 cases we processed, resolved, completed, and closed, 7,141 were liability cases (56.0%), such as auto, medical malpractice, products liability, nursing home, and home owners cases. 5,270 were no‐fault cases (41.4%), such as auto no‐fault, med pay, and personal injury protection claims. 333 were work comp cases (2.6%), including state and federal work comp, and longshore harbor claims.
Liability, no‐fault, and work comp clients have saved $27.6 million in Medicare conditional payments.
On average, Flagship saves liability, no‐fault, and work comp clients 67% of the initial CMS request for reimbursement.
Taking into consideration all 12,744 cases handled, the $41.2 million total conditional payments requested by CMS, and the $27.6 million in total savings, on average, Flagship has saved its clients 67% of the initial CMS request for reimbursement (55.5% on 7,141 liability cases, 87.7% on 5,270 no‐fault cases, and 77.7% on 333 work comp cases).
Out of 12,744 cases, savings was found in 54% of the liability, no‐fault, and work comp claims.
Of the 12,744 liability, no‐fault, and work comp conditional payment cases Flagship processed, resolved, completed and closed, 5,866 (46%) had no conditional payment amounts. The remaining 6,878 cases (54%) had conditional payments. 3,615 cases (28.4%) had conditional payments between $1 and $1,000, 2,310 cases (18.1%) had conditional payments between $1,001 and $10,000, and 953 cases (7.5%) had conditional payments over $10,001.
On average, Flagship saves liability, no‐fault, and work comp clients $4,012.27 per case.
In the 6,878 liability, no‐fault, and work comp claims in which Flagship was able to assist its clients in reducing conditional payments, the average conditional payment requested by CMS was $5,989.75. After Flagship reviewed, analyzed, disputed, and appealed such payments, CMS ultimately reduced its demand to an average of $1,977.48, thereby saving our liability, no‐fault, and work comp clients an average of $4,012.27 per case (average of $4,728.94 in 3,896 liability claims, $4,285.10 in 2,837 no‐fault claims, and $6,431.17 in 145 work comp claims).
After fees, Flagship clients still saved $21.1 million in liability, no‐fault, and work comp conditional payment claims.
Our conditional payment services pay for themselves. After fees, Flagship liability, no‐fault, and work comp clients still saved a total of $21,148,067 ($10.9 million in liability cases, $9.5 million in no‐fault cases, and $.75 million in work comp cases).
Average return on investment is 328%.
Flagship liability, no‐fault, and work comp clients have enjoyed an unmatched return on investment. On average, Flagship’s unparalleled return on investment to its clients was 328% based on net savings to total fees (an average of 301% ROI on 7,141 liability cases, 361% ROI on 5,270 no‐fault cases, and 387% ROI on 333 work comp cases).
About Flagship Services Group
Flagship Services Group is the premier Medicare and Medicaid compliance services provider to the property & casualty insurance industry. Our focus and expertise has been and remains the Medicare and Medicaid compliance needs of P&C insurers, third party administrators, and self‐insureds. We specialize in P&C mandatory reporting, conditional payment resolution, and set aside allocations. Whether auto, liability, no‐fault, or work comp claims, we have assembled the expertise, experience and resources to deliver unparalleled MSP compliance and cost savings results to the P&C industry.
- How far is too far when negotiating Medicare release terms? (10/7/2019) - At the recent NAMSAP Educational Conference in Baltimore, during a breakout panel discussion on “Leveraging Settlement with Medicare Set-Asides in Mediation”, a rather strident concern was raised with respect to the reasonable scope of terms in a settlement release irrespective of the type of primary plan covering the loss. Specifically, attendees questioned whether Medicare eligible individuals could or to what extent may release their claim or claims in the future to these public health and welfare insurance benefits while negotiating compromise settlement provisions under liability, no-fault or workers compensation plan.
- Treasury Trove (9/17/2019) - Medicare is paid for through two Trust Fund accounts—Hospital Insurance and Supplementary Medical Insurance—held by the United States Department of Treasury, How Is Medicare Funded. In 2018, over 60 million people were covered by Medicare with over $731 billion in total expenditures from the Trust Funds Facts on Medicare Spending and Financing. Further, CMS reports validating $493.68 million in recoverable mistaken conditional payments, while returning $98.68 million dollars to the Medicare Trust Funds in 2018 as a direct result of its recovery program activities, on top of $131.78 million in 2017, MSPRC Commercial Repayment Center in Fiscal Year 2018. Collection activity by the United States Department of Treasury (DOT) on Medicare conditional payments is reportedly increasing in 2019, plus, over the past 15 months, the United States Department of Justice reached six-figure settlements with two Plaintiff’s law firms for failure to repay Medicare conditional payments.
- CMS Favors Professionally Administered Lump Sum MSA (9/5/2019) - 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.