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What to Watch for in 2020

Politics:

Which ideas will rise to the top in the 2020 Presidential election where each candidate seems to advance different positions and goals on health care, and Medicare’s role, which many polls suggest remains the top issue:  Providing Americans the healthcare they need and improving access to affordable, quality healthcare… Bring down costs and increase access to quality care… Combat the opioid addiction crisis… Bring down the cost of prescription drugs… Expand choices and alternatives to Obamacare plans and increase competition to bring down costs for consumers…  Protect and build on the Affordable Care Act… Expand Obamacare and Medicare to achieve universal coverage… Medicare for all… Medicare for all who want it… Medicare plus a choice of either complimentary or supplementary private insurance.

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This Little Light of Mine

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.

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Are You My Mother?

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.

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Into the Looking Glass

Business organizations face all kinds of risk.  Developing strategic risk management plans as a business practice is becoming more prevalent across industry lines which help the organization define, measure, anticipate, and respond, for example, to foreseeable risks, technological developments, as well as changing laws and regulations.  Some risk is insurable, while other kinds may necessitate capital, cost or other investment such as an organization adding new personnel or contracting with subject matter specialists or consultants.  Some risk is not as perceptible as others, yet still must be handled if it occurs.  Ideally, an effective risk management plan is tailored to the organization and ultimately improves its performance by avoiding, minimizing or mitigating risk.

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Ghostbusters

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.

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How far is too far when negotiating Medicare release terms?

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.

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Treasury Trove

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.

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Top 10 MSP Compliance Waypoints in 2019

Key moments, thus far, to review and consider on the 2019 Medicare Secondary Payer voyage. Medicare Secondary Payer compliance can be complex with many changes to track from different and connected sources which affect administrative policies, procedures and processes.  Flagship’s educational solutions are thoughtfully designed to explain matters in simple terms which help your team be informed and equipped to seriously chart an easier and safer compliance course.

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Flagship Welcomes Robert J. Finley as Chief Legal Consultant

August 5, 2019

Valued Flagship Clients,

Flagship Services Group, is pleased to announce that Robert J. Finley will serve as our Chief Legal Consultant. We are excited to work with Mr. Finley, who brings both knowledge and practical experience in Medicare Secondary Payer (MSP) compliance and regulation, as well as Medicaid third party liability and reimbursement matters.

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