Posts Tagged ‘Advice’
Wednesday, March 31st, 2010
QUESTION: 
Will the new Health Care Reform Law have any affect on ERISA plans and subrogation in the future? – FL Attorney
ANSWER:
Right now there are many unknown variables regarding ERISA plans and the new Patient Protection and Affordable Care Act of 2010 that was signed into law on March 23, 2010. What we do know is that health insurance practices, including Subrogation and Recovery will experience changes over the next few years.
The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets minimum standards for most voluntarily established pension and health plans in private industry to provide protection for individuals in these plans (US Department of Labor, www.dol.gov). Employer provided health plans are governed by ERISA, which also loosely defines their right of recovery, allowing for “appropriate equitable relief” (29 USC 1132(a)(3)). Plans that are Read the rest of this entry »
Tags: Advice, Ask a Lien Professional, ERISA, Evaluation, Lien Resolution, Plan Language, Reform
Posted in Lien Resolution | No Comments »
Thursday, February 18th, 2010
I have a case that has a private insurance lien. I sent in a notice to the insurer, but got a response from another company. What do I do with this? - Orlando Attorney
Answer:
When resolving a possible lien with a private insurer, it is important to know who the involved parties are, and their role in the resolution of a case. You have received a response from a “Recovery Contractor” which is a separate company hired by the insurer to address all subrogation and recovery issues on their behalf. Recovery contractors have the authority to initiate collection activity against the insured, to provide information about the claims included in the lien, and act as the liaison between the lien holder and the insured in matters of lien negotiation. In order to get the best results from a recovery contractor, there are three things you should know.
1. They want to recover as much as possible – even if they aren’t entitled to it!
Recovery contractors are a lot like collection agencies. They want to recover as much as possible, because in some cases, it adds to their bottom line. The problem with that is, the amount that is submitted for payment is not always the amount that the claimant should have to pay. It is important to audit the claims included in the lien to be sure that they are all related to the compensable injury. Even more important is the evaluation of the plan language and plan type before making any offers or payments.
Tags: Advice, Ask a Lien Professional, ERISA, FEHBA, Help, Insurance, Plan Language, Questions
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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.
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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Tags: Advice, asbestos, Medicare, mesothelioma, VA
Posted in Ask a Lien Professional, Lien Resolution | 4 Comments »
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]](http://www.liensettlementsolutions.com/lienresolution/wp-content/uploads/2009/10/DenialsByInsurer20082.jpg "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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Tags: Advice, Billing, Compliance, Conditional Payments, Denied Claims, Medicare, Provider, Tips
Posted in Medicare | No Comments »
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 »
Tags: Advice, Ask a Lien Professional, Billing, Florida, Hospital, Medicaid, Provider, Questions
Posted in Ask a Lien Professional | No Comments »
Friday, September 25th, 2009
A Medicare Insider’s Clarification on MSA Confusion
According to Section 111 of the MMSEA (Medicare, Medicaid &SCHIP Extension Act), primary payers are to (1) identify the Medicare eligibility status of plaintiffs and (2) report all Medicare beneficiaries to Health and Human Services when there is a settlement, judgment, or award that is taking place in Workers Compensation, Liability, and No Fault claim. CMS has reiterated that the MMSEA provision does not change or eliminate any existing obligations for the handling of Medicare Set Asides (“MSA”). It is crucial to understand that the Section 111 MMSEA reporting requirements are a completely separate matter from MSAs.
The misinformation that trial lawyers have received is creating great confusion with regard to what is required under the Medicare Secondary Payer Act (“MSP”) when settling future medical in a liability claim. Is an MSA necessary or not? Those entities that have taken the position that an MSA is “required” in liability settlements likely have financial incentives for taking that position. The only answer regarding whether you have to set up an MSA in liability cases is that there simply are no definitive answers. With the absence of specific statutory or regulatory language mandating that an MSA be completed in a liability claim, it is left up to the trial lawyer to interpret current law and CMS pronouncements to decide whether it is appropriate to establish an MSA.
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Tags: Advice, Compliance, Help, Liability, Medicare, MSA, Questions, Reporting, Tips
Posted in Medicare | No Comments »
Wednesday, September 23rd, 2009
Quick tips that can move your settlement to the Head of the Class!
A – Allocation: When in the process of negotiating a settlement and determining the allocation of proceeds, be mindful of any outstanding lien obligations. Some plans may have a right to recover from the full value of the settlement if an allocation does not protect their interest.
B – Bargaining with a provider or recovery agent can be worthwhile if there is a clear understanding of the strength or weakness of their right of recovery. Make them an offer they can’t refuse!
C – Call! Regular communication is necessary, especially when resolving with Medicare, Mediaid or the Military Health Plans. Remember, the squeaky wheel gets the oil!
D – Delegate: When the task of Lien Resolution becomes to overwhelming, delegate this aspect of case management to the PROs! Lien Settlement Solutions offers programs that meet all of your lien resolution needs. Call us at (877)907- LIEN to speak to one of our representatives! Read the rest of this entry »
Tags: Advice, Compliance, ERISA, Evaluation, Help, Lien Resolution, Medicaid, Medicare, Questions, Tips, Tricare, VA
Posted in Lien Resolution | No Comments »
