In CMS’ efforts to improve the quality of care, as of October 1, 2008 Medicare will not pay for certain injuries/conditions acquired during inpatient care, these injuries/conditions have been named by CMS as “never events” or “hospital acquired conditions” (HACs). CMS has advised state Medicaid Agencies to amend their statutory language to ensure that payment is not made through Medicaid for those beneficiaries that may have dual eligibility. Read the rest of this entry »
Posts Tagged ‘Medicaid’
Malpractice- Medicare will not pay for “Hospital Acquired Conditions a.k.a “Never Events”
Wednesday, May 19th, 2010Ask a Lien Professional – Provider refuses to bill Medicaid!
Thursday, October 8th, 2009Question:
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 »
The ABCs of Lien Resolution
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 »
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LIEN Settlement Solutions, LLC
1500 E. Robinson St.
Orlando, FL 32801Toll Free 877.907.LIEN (5436)
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