It’s hard to imagine, but every single claim reported to Medicare under Section 111 reporting requirements has the potential to generate 199 error codes! The full list is available online from CMS in the reporting user guide.
Resolving a Medicare lien can be costlier and more time consuming than most other claims of similar value and complexity. Part of the reason for this is the relative rarity with which your claims adjusters process these claims. Part of it comes from the fact that Medicare regulations are constantly evolving. And, of course, the intricacies of properly reporting and filing these claims simply take a long time to complete.
We’ve established a simple, three step process for effectively resolving Medicare liens – and really, handling all Medicare compliance issues your company is faced with – quickly and efficiently.
Maintaining compliance with Medicare rules and regulations can be compared to marketing a small business: you could do it yourself, and you might have some success, but if you hire a professional, you’ll have more time, better results, and your savings will be significantly higher.
The hidden internal costs of DIY compliance
As a P&C insurance organization, your company employs dozens – perhaps hundreds – of claims adjusters who deal with a huge volume of claims over the course of a month. Only about 17% of those claims involve Medicare beneficiaries and only a portion of those claims fit the requirements for Section 111 reporting and repayment of conditional payments. Read more
Every few months a new change – major or minor – rocks the Medicare compliance industry, leaving many insurers scrambling to keep up. These constant changes put a strain on internal training departments where Medicare Compliance is handled in-house as they need to continually update the claims adjusters on the newest guidelines.
Achieving 100% compliance when dealing with Medicare as a secondary payer is not easy. It’s a difficult, time-consuming, and labor-intensive effort, and one that many P&C insurance companies fail to give the priority it deserves.
The complexity and difficulty rises from the fact that the detailed rules and regulations involved are constantly changing. Plus, the average claims adjuster only sees a few Medicare-related claims a month. To help get a claims adjuster on the road to compliance, here are 5 core steps to follow. Read more
The issue of Medicare Set Asides (MSAs) is known to cause confusion and frustration for insurers. So, we want to provide a brief explanation to help settle some of the confusion and resolve some of the frustration that comes along with trying to keep up with changes in the Section 111 reporting and recovery regulations – including MSA rules.
We’ve worked with all sorts of clients over the years: large and small, public and private. One thing we run into over and over again is that these companies simply do not understand the level of risk they are exposed to when it comes to Medicare compliance.
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.
As a Responsible Reporting Entity (RRE), it’s not an option to inaccurately or incompletely report Medicare-related settlement claims under Section 111 requirements. It also doesn’t make sense to report them properly, then fail to submit payment to Medicare. In both cases, the penalties are too steep to justify any sort of negligence.
The advent of new and improved technology for data collection is continually improving efficiencies for P&C Insurers. However, you still have to know how to use and analyze this data to improve Medicare reporting and compliance.