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.
- Ghostbusters (11/1/2019) - In 1984, Ivy League trained parapsychologists Venkman, Stantz, and Spengler started a ghost-catching business in New York City, despite implausible research, and eventually were welcomed as heroes by saving the city from the paranormal disguised as giant marshmallow man Stay Puft. Only in the movies! But, we can use this ghoulish time of the year to serve as a reminder: Don’t let MSP enforcement claims by Medicare Part C Advantage Plans sneak up to shock and detract your standard claims operating procedures. Identifying and resolving these repayment claims may be just as important a part to your overall MSP compliance strategy as similar claims by traditional Medicare Parts A and B.
- 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.