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Archive for October, 2009

Asbestos & Lien Resolution

Thursday, October 29th, 2009

Important Information for Resolving Liens in Asbestos Cases 

Asbestos Exposure cases are unique when it comes to lien resolution because of factors that are unlike any other type of litigation.  Unlike a pharmaceutical case where the illness develops within a 1-3 year period, most asbestos-related diseases are diagnosed decades after the initial exposure.  By the time Mesothelioma or Asbestosis are detected, the claimant is usually a retiree.  In managing an Asbestos caseload, it is important to know what the lien obligations are, especially when dealing with multiple defendants.  Origin of exposure, military service, dates of exposure, and whether the exposure is from a primary or secondary source are all important factors that impact the resolution of health insurance liens.

Asbestos Fibers

Due to the 15 – 40 year latency period for the development of Mesothelioma, and 10 – 20 year latency period for Asbestosis, most asbestos claimants are over the age of 65.  Many claimants receive Medicare, Medicaid, and VA health care benefits.  It is important to know the recovery rights of these insurers before going forward with your case.

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Medicare Denied Claims and Conditional Payments

Thursday, October 29th, 2009

Medicare claim denial is unfortunately a common problem that Medicare beneficiaries are faced with.  Medicare has the highest denial rate of any insurer pursuant to the 2008 National Health Insurer Report Card commissioned by the American Medical Association (AMA, www.ama-assn.org):

  DenialsByInsurer2008[2]

Before we start making hasty assumptions about government health care programs, lets look at some of the reasons why claims have been denied by Medicare.  33.6% of adjustments and 33.7% of denials are due to inaccurate reporting by the providers.  Some of the common billing errors that providers make are: 

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MMSEA Update & News – October 2009

Wednesday, October 28th, 2009

Notes from the recent CMS Town Hall Teleconference on October 22, 2009:

We are rapidly approaching the date for live reporting to CMS for all Workers Compensation, Liability, and No Fault claims, 4/1/2010.  The registration deadline for RRE’s (insurers) was 9/30/09, but CMS has opted to leave the registering process open.  CMS has ensured the industry that those entities that were not registered prior to 10/1/09 will not be penalized, but it is expected that all RRE’s will be registered by the end of the year. 

Due to misinterpretation of the law under MMSEA plaintiff attorneys have been left overwhelmingly frustrated with the varying opinions in regard to whether or not a Liability MSA is now required under MMSEA?  By now plaintiff attorneys should be apprised that, although MMSEA Section 111 has nothing to do with Medicare Set-Asides, it does not dismiss the necessity of protecting Medicare’s interest in Liability cases.

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This Just In… VA Budget Act Signed

Wednesday, October 28th, 2009
 President Obama Signs the Veterans Health Care Budget Reform and Transparency Act of 2009
obama-signs-bill
 
On October 22, 2009 President Obama signed the Veterans Health Care Budget Reform and Transparency Act of 2009, calling it “the most significant victory for veterans in a generation”.  This legislation ensures that the Department of Veterans Affairs can continue to provide adequate funding for health care benefits, facilities, and programs, even through years when Congress has yet to approve a  budget.  This bill was designed to avoid lapses in funding, allowing Congress to authorize advance funds to meet the demands of the health care services provided by the VA to over 7.84 millionVA health care enrollees.  According to Arthur Wilson of the Disabled American Veterans Organization (DAV), “with funding assured, VA Hospital and clinic directors will no longer have to delay the hiring of new doctors or nurses, or the purchase of new medical equipment, due to Confgress’ failure to approve a budget on time…” (Reuters, 10/22/2009).
For more information on the Department of Veterans Affairs, visit www.va.gov.  If you have a VA lien issue, contact Lien Settlement Solutions at (877)907-5436 for assistance.

FJA Seminar – October 15, 2009 – Liability MSAs

Wednesday, October 28th, 2009

On October 15 – 16, 2009  Delta Settlement Solutions was a sponsor at the Florida Justice Association Seminar, held in Orlando, FL.   The event was a great way to meet and greet our colleagues and introduce our services.  Erica Cooper, Manager of Medicare Services and Compliance of Lien Settlement Solutions (a Delta Company) gave a comprehensive presentation regarding compliance under the MSP statute, titled “CMS Compliance Does Not Have To Be A Nightmare”.   Below, Erica gives her thoughts, observations of the event, and additional insight into Liability MSAs.

 The Florida Justice Association is a great organization.   I have had the opportunity to learn the admirable members of the FJA as well as the broad education and strong foundation it provides to our legal community.  It is a privilege to support a group such as the FJA.

Many of the participants in attendance expressed great concern when handling Liability cases and whether or not an MSA is required?  For whatever the reason the industry has made an already complex matter more difficult to implement in attorneys day to day practice.  So allow me to provide as much clarity as I can regarding this matter.

We first have to remember that MMSEA Section 111 has nothing to do with Medicare Set-Asides.  Secondly an MSA is only considered such when an allocation is submitted to CMS.  Otherwise, when an analysis of future medical costs is created it is simply an allocation. 

Protecting Medicare’s interest is relevant to all Workers Compensation, Liability, and No Fault claims.  For both past and future medical expenses paid and that can be expected to be paid.  Lack of a “formal” review process by CMS for proposed Liability MSA’s, does not dismiss the necessity of an allocation to protect Medicare’s interest for future medical expenses.  When addressing this topic there are two questions: 

1)      Do you need to allocate?

2)      Do you need to submit the allocation to CMS for review? 

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New Alerts from Medicare MSP

Tuesday, October 13th, 2009

ExclamationPoint-main_FullMedicare MSP has made new changes to their processes effective October 1, 2009.  The following updates are from the www.msprc.info website:

 

ALERT – Rights and Responsibilities

Effective for cases established on or after October 1, 2009, the “Right to Recovery Letter” issued when a claim for liability insurance (including self-insurance), no-fault insurance, or workers’ compensation is reported to CMS’ Coordination of Benefits Contractor (COBC) will no longer be issued by the COBC. The letter has been revised, renamed (it is now the “Medicare Secondary Payer Rights and Responsibilities” letter) and will be issued by the MSPRC.
Note: If you received a “Right to Recovery Letter” issued by the COBC and dated on or before September 30, 2009, you may follow the instruction in that letter regarding submitting a “Consent to Release” document.

ALERT – Proof of Representation

New information is available on this site regarding “proof of representation” and “consent to release” documentation. Please refer to the PowerPoint presentation titled: “Rules and Model Language for ‘Proof of Representation’ vs. ‘Consent to Release’ for Medicare Secondary Payer Liability Insurance (Including Self-Insurance), No-Fault Insurance, or Workers’ Compensation” as well as the pdf. documents with model language. See under the “Proof of Representation” section below.

ALERT – Interim Conditional Payment

Effective October 1, 2009, the MSPRC will issue information concerning interim conditional payment amounts automatically (that is, without receiving a request for such information) as soon as an interim conditional payment amount is available. If you have an outstanding request for a conditional payment letter (CPL) for a case established prior to October 1, 2009, the request will be processed in the order received. For all new cases, the Medicare beneficiary and any authorized individuals will receive the CPL within 65 days of the issuance of the “Rights and Responsibilities Letter.” Please refer to the discussion in the “Rights and Responsibilities Letter” or the “Rights and Responsibilities Brochure” for further information.

Ask a Lien Professional – Provider refuses to bill Medicaid!

Thursday, October 8th, 2009

Question:

I have a case where the hospital has a claim that needs to be submitted to Medicaid for payment.  However, since the hospital knows that there is a liable third party, they are refusing to submit the claim to Medicaid.  How can I force the hospital billing office to submit the claim for payment?  – FL Attorney

Answer:

In this instance, the provider has the right to go either way, so there is no real avenue to “force” a provider to bill Medicaid for services.  Under Medicaid’s provider agreement, the hospital has the right to bill all other insurers first, with Medicaid being the final payer.   On the other hand, Medicaid has the right to subrogate for payments made when a third party is responsible. 

Medicaid as Final Payer – Why the Provider can bill liable insurer: 

 FL Statute 409.907(3)(f) – Medicaid Provider Agreement

 (3)  The provider agreement developed by the agency, in addition to the requirements specified in subsections (1) and (2), shall require the provider to: Read the rest of this entry »

Give Us a Try! $500 Lien Resolution – The LSS Test Drive!

Friday, October 2nd, 2009

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Our regular fee schedule is reduced to $500.00 for ALL FIRST TIME CLIENTS of

Lien Settlement Solutions for cases referred before December 31, 2009.

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To show you that Lien Settlement Solutions is YOUR solution to Lien Resolution!

Give Lien Settlement Solutions a Test Drive; you’ll be glad that you did!!

 

Valid for one (1) case only, unless otherwise stated by LSS representative.  Offer expires December 31, 2009.  Visit www.liensettlementsolutions.com for Intake and Authorization Forms.  Call (877)907-5436 for additional information.