Compliance

4/9/2018 - 3 min read

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.

3/19/2018 - 7 min read

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.

3/15/2018 - 3 min read

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Insurers need to act expeditiously to update their forms that are outdated and ensure that their cancellation and nonrenewal provisions are consistent with the law.

2/28/2018 - 7 min read

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.

2/12/2018 - 2 min read

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.

1/29/2018 - 2 min read

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 of injury and subsequent reports of injury. The newest version of these standards is the IAIABC EDI Release 3.1, scheduled to be implemented September 2018.

1/29/2018 - 7 min read

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 months, however, a number of state Medicaid agencies have more vigorously asserted their recovery rights.

1/12/2018 - 3 min read

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) statute remains a major concern for the claims industry.

12/1/2017 - 5 min read

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.

11/27/2017 - 6 min read

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 recovery arena.

6/27/2017 - 1 min read

P/C insurers see 42.2 percent drop in net income in Q1 2017

6/16/2017 - 6 min read

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.

5/22/2017 - 4 min read

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.

5/17/2017 - 5 min read

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.

12/13/2016 - 3 min read

High Quality Analytics from High Quality Data: The ISO Data Quality Review Process