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Centers for Medicare & Medicaid Services (CMS)

Marvin Tolentino 680683 Unsplash
September 19, 2016

The compliance gap: How you see your compliance vs. how Medicare sees it

There are two main categories of Medicare compliance: (1) reporting and (2) recovery. Although the law and regulations clearly state what must be done in each category…

September 16, 2016

Should you purchase MSA liability insurance?

Medicare Set-Asides (MSAs) are primarily a coordination of benefits tool. The failure to obtain & adequately fund an MSA can result in a denial of payment.

Melissa Walker Horn 1081246 Unsplash
August 18, 2016

MSP statute extends its reach in the 11th Circuit: Foreshadowing for liability MSAs?

Undoubtedly, the 11th Circuit Court decision in Humana has obvious financial consequences to insurers.

Per Loov 1347213 Unsplash
June 21, 2016

New front in Medicare Advantage battle: Law firm targeted

We continue to watch closely the expansion of Medicare Secondary Payer (MSP) recovery concepts to cases involving Medicare Advantage Plans (MAPs).

Zhen Hu 340739 Unsplash
May 9, 2016

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…

Headway 537308 Unsplash
May 9, 2016

Top five tips to get a handle on conditional payments

Conditional payments are one of the biggest challenges insurers face when resolving a case with a Medicare beneficiary.

Bannon Morrissy 1437656 Unsplash
February 10, 2016

Liability or workers' comp? Federal Employment Acts and the MSP

When it comes to Medicare Secondary Payer (MSP) compliance, we usually make a distinction between workers' compensation and liability insurance claims. Different elements…

December 7, 2015

Avoiding the snares of the Treasury Offset Program

When a Medicare conditional payment case is referred to the U.S. Department of Treasury for collection, the Debt Management Services office in Birmingham, Alabama, and…

Pawel Czerwinski 1229365 Unsplash
July 29, 2015

Medication trends to watch

It’s no surprise that prescription medications are often the biggest cost driver in a Medicare Set-Aside (MSA).

Ani Kolleshi 684082 Unsplash
July 29, 2015

Impact of utilization review on Medicare Set-Asides

Although Utilization Reviews (URs) and Independent Medical Reviews (IMRs) have been used in state jurisdictions for years, insurers have only recently focused on how the…

Trent Erwin Uga3xvi3ska Unsplash
June 22, 2015

Medicare conditional payment compliance: Myth vs. fact

The statutes and regulations that govern Medicare have been referred to by courts as “the most completely impenetrable texts within human experience.” With the complex…

November 17, 2014

Court rules that employer does not have to fund higher WCMSA amount

In Hunter v. Rapides Parish School Board, No. 14-490, 2014 WL 5669206 (La. App. 3rd , Nov. 5, 2014), the Louisiana appeals court held that the employer was not required…

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