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…
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.
Undoubtedly, the 11th Circuit Court decision in Humana has obvious financial consequences to insurers.
We continue to watch closely the expansion of Medicare Secondary Payer (MSP) recovery concepts to cases involving Medicare Advantage Plans (MAPs).
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…
Conditional payments are one of the biggest challenges insurers face when resolving a case with a Medicare beneficiary.
When it comes to Medicare Secondary Payer (MSP) compliance, we usually make a distinction between workers' compensation and liability insurance claims. Different elements…
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…
It’s no surprise that prescription medications are often the biggest cost driver in a Medicare Set-Aside (MSA).
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…
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…
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…