Compliance

11/11/2016 - 4 min read

Removing roadblocks to settlements: Medicare Part C claims in the way of your settlement

The last half-dozen years have seen Medicare Secondary Payer (MSP) compliance evolve, with the most recent example being its change in focus from mandatory insurer reporting to rolling recovery.

9/29/2016 - 3 min read

The SPARC Act may have implications for future Medicare Advantage Plan rulings

On September 22, Congressmen Tim Murphy (R-PA) and Ron Kind (D-WI) introduced legislation designed to clarify the Medicare Secondary Payer (MSP).

9/19/2016 - 4 min read

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 and who must comply, the actual process of compliance can be quite challenging.

9/16/2016 - 1 min read

Tennessee making final push for full implementation of EIVS

Tennessee announced progress in its goal to have all carriers submit their Book of Business (BoB) files to its Electronic Insurance Verification System (EIVS).

9/8/2016 - 3 min read

Medicare Advantage Plans allowed to sue no-fault carriers for private cause of action

New ruling likely to lead to more MAP lien claims against PIP insurers.

8/19/2016 - 4 min read

Preparing for a fundamental compliance shift in liability claims

Liability claims are particularly at risk, as these emerging compliance issues impose new burdens on the management and settlement of claims.

8/18/2016 - 4 min read

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.

8/17/2016 - 4 min read

The impact of Medicare Advantage Plans on your claims: The risk of double damages and summary judgment

The decision will have a significant impact on liability, workers compensation, and no-fault claims being handled.

8/16/2016 - 5 min read

Removing impediments to settlements: Conditional payments in liability claims

While liability conditional payments can present some unique challenges, there are effective methods to remove the stumbling blocks to claims resolution.

8/12/2016 - 5 min read

Breaking news: 11th Circuit rules Medicare Advantage Plans can sue in federal court

The Eleventh Circuit Court of Appeals expanded the rights of Medicare Advantage Organizations (MAOs) to use federal court to sue primary payers.

6/21/2016 - 4 min read

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).

6/6/2016 - 2 min read

Settlement language strikes again, new case proves clear provisions are critical

Settlement language is an important aspect of Medicare Secondary Payer (MSP) claims that demands careful consideration.

5/9/2016 - 3 min read

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 Services (CMS) to pigeonhole non-group health plans (NGHP) into either workers' compensation, liability, or no-fault.

5/9/2016 - 3 min read

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.

4/12/2016 - 2 min read

Unique solutions to 2016 industry challenges

Insurers are facing tough challenges in 2016 and ISO Claims Partners is working with you to meet these challenges in unique ways.