Centers for Medicare & Medicaid Services (CMS)
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…
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.
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.
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).
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…
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.
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…
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…
Medication trends to watch
It’s no surprise that prescription medications are often the biggest cost driver in a Medicare Set-Aside (MSA).
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…
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…
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…