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.
- Progressive Insurance Company Settles Medicare and Medicaid Secondary Payer False Claims Act for $2.4 Million (11/22/2018)- Auto, liability, no-fault, and work comp primary payers- if you didn’t take Medicare and Medicaid secondary payer issues seriously before, here are over 2 million reasons why you should. On November 14, 2017, the United States of America, the State of New Jersey, Progressive Garden State Insurance Company, Progressive Casualty Insurance Company, and Relator Elizabeth […]
- 2019 Thresholds (11/20/2018)- The SMART Act requires the Centers for Medicare & Medicaid Services (CMS) to review its costs related to recovering conditional payments compared to recovery amounts annually. After their analysis, CMS announced the reporting thresholds for Liability, No-Fault and Workers Compensation claims for 2019. CMS calculated a threshold for physical trauma-based liability insurance settlements. “Effective January […]
- Bilirakis and Kind Introduce PAID Act, Requiring CMS Provide Identity of Advantage, Prescription, and Medicaid Plans (6/4/2018)- Rafael Gonzalez, Esq., President, Flagship Services Group On May 18, 2018, Congressman Gus Bilirakis (R-FL) and Congressman Ron Kind (D-WI) introduced HR 5881, amending the Medicare Secondary Payer (MSP) statute and clarifying its application to Medicare Part C Advantage Plans (MAP), Medicare Part D Prescription Drug Plans (PDP), and Medicaid. The Provide Accurate Information […]