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.
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- This Little Light of Mine (12/31/2019) - Earlier this month, a lively lunchtime discussion turned to the subject of Section 111 reporting—past and future—as well as CMS’ pending Notice of Proposed Rulemaking. Various voices ventilating on the uncertainty and confusion over statutory $1,000 per day penalties…rulemaking delays…recent court decisions.
- Are You My Mother? (12/3/2019) - In Dr. Seuss’ classic book, a determined baby bird is searching for his mother but does not know what she looks like. Under Medicare Secondary Payer (MSP), certain insurers encounter similar problems trying to figure out whether it is a Primary Plan with Section 111 and reimbursement obligations.