Compliance
Proactive data management key to handling EDI reporting challenges
When IAIABC published its newest standard for workers’ compensation EDI data reporting, Release 3.1, one thing was certain—compliance would get a lot more complex.
Medicare Advantage update: Connecticut court rules MAPs can pursue “double damages” under the Medicare Secondary Payer statute
Connecticut is the latest jurisdiction to address whether MAPs have private cause of action (PCA) rights to pursue “double damages” under the MSP statute.
Keeping all your forms in harmony
Insurers need to act expeditiously to update their forms that are outdated and ensure that their cancellation and nonrenewal provisions are consistent with the law.
Medicare watch list: Staying ahead of the Medicare Secondary Payer compliance curve
As another new year settles in, we know at least one thing is certain: MSP compliance will continue to present formidable challenges for claims payers.
Budget Act of 2018 limits Medicaid third-party recovery rights
While most of the headlines focused on the deal’s impact on military expenditures and other issues, the new law also contained an update regarding MSP compliance.
Changes on the horizon for workers’ compensation claims with IAIABC EDI Release 3.1
A growing number of states have chosen to implement a more efficient, paperless claims-reporting process by using the IAIABC workers’ comp EDI Standard for first reports…
Now hear this: Medicaid Secondary Payer recovery on the rise
Historically, state Medicaid agencies have been rather flat-footed in making efforts to identify and recoup erroneous payments from non-group health entities. In recent…
Medicare Advantage Plans update: Illinois court indicates MAPs have “double damages” rights
Whether Medicare Advantage Plans have private cause of action rights to sue claims payers (and others) for “double damages” under the Medicare Secondary Payer (MSP)…
Court declines to rule on whether LMSA is necessary - Cites no legal authority for MSAs in liability cases
Whether liability Medicare set-asides (LMSAs) are legally “required” continues to be a vexing question for parties settling liability claims.
Medicare Part D - The next recovery frontier?
Spurred by a number of favorable court decisions allowing MAPs to sue for “double damages” under the MSP statute, Medicare Part D plans are now beginning to step into the…
P/C insurers see 42.2 percent drop in net income in Q1 2017
The P/C insurance industry’s net income after taxes dropped to $7.7 billion in first-quarter 2017 from $13.4 billion in first-quarter 2016—a 42.2 percent decline.
Court blocks Medicare discovery requests - Ruling limits insurer's ability to determine MMSEA obligations
A new case out of Connecticut highlights complications insurers can encounter in obtaining information to assess their MSP compliance obligations.
New realities: The Section 111 connection to conditional payments and claim outcomes
Section 111 reporting used to be viewed as an abstract technical Medicare compliance obligation & IT's responsibility because of the data transmission.
Risky business: Five essential tips for Section 111 reporting
Your Section 111 reporting program may seem clear-cut, but it can mean risky business if your team isn’t prepared to avoid common compliance mistakes.
High Quality Analytics from High Quality Data: The ISO Data Quality Review Process
High-quality analytics are critical to evaluating and managing risk. But you can’t produce high-quality analytics without high-quality data.