Kate Riordan
The impact of Medicare Advantage Plans on your claims: The risk of double damages and summary judgment
The decision will have a significant impact on liability, workers compensation, and no-fault claims being handled.
Untangling the confusion of Accident & Health policies
Medicare compliance often requires that different policy types be grouped together into one set of claims. It’s the practice of the Centers for Medicare & Medicaid…
Medicare Secondary Payer implication indicated in proposed 2017 budget
The President’s fiscal year (FY) 2017 budget, which starts October 1, 2016, proposes $4.1 trillion in spending. Of this, an estimated $1.0 trillion in mandatory and…
California becomes fifth state to require closed drug formulary for workers' compensation claims
California Governor Jerry Brown has signed Assembly Bill No. 1124, which mandates that the Division of Workers’ Compensation (DWC) implement a prescription drug formulary…
Preparing for ICD-10: are you ready?
For the past year, it’s been difficult to overlook the numerous reminders from the Centers for Medicare and Medicaid Services (CMS) regarding the upcoming transition from…
California’s independent medical review: Pursuing necessary and appropriate care
California uses Independent Medical Reviews (IMRs) to resolve disputes regarding medical treatment for injured employees. This process was enacted by way of a landmark…
Medicare Advantage strikes again: Humana v. Western Heritage
The last few years have seen several key cases regarding the evolving issue of what rights Medicare Advantage organizations (MAOs) have when seeking recovery in a primary…
ICD-10 update
One of the most important developments in Medicare Secondary Payer compliance for 2015 will be the transition from ICD-9 codes to ICD-10 codes on October 1, 2015. On that…
Court allows Medicare Advantage plan’s suit for double damages to proceed
In an important development on the Medicare Advantage (MA) front, the court in Humana v. Farmers Texas County Mutual Insurance Company, et. al, No. 13-CV-611-LY (W.D.…