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Tevra Johnson, Director of Lien Resolution and Medicare Compliance shares tips, news, and facts about subrogation, reporting, compliance, and everything in between. For more information about Lien Settlement Solutions and our services, contact us at info@lienss.com, or by phone at (877)907-5436.
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.
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?
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 »
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.
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 »
Dear Lien Settlement Solutions;
I’ve got a settlement and an 18 y/o client whose mother works for the federal government. All the medical bills appear to have been paid by the mother’s private insurance company, but I suppose that they may be the administrator. This is an Anti Subrogation state, but we assume that FEHBA plans are preempted. We have received no notice from the FEHBA or Private Insurer plans about any sort of subrogation interest. Have you been down this road before?
- Confused in the Carolinas
In reviewing FEHBA subrogation, it generally preempts state law and is not beholden to ERISA law in which North Carolina is an Anti Subrogation state for some insured plans. I’ve been looking for any type of loophole where NC’s anti subrogation can be can be argued for a FEHB plan, but everything I’ve found is to the contrary. The strength of the right of recovery in a FEHBA plan lies in the specific description within the plan.
I looked through a few plans to get an idea on how NC FEHBA plans are written. Specifically, I reviewed the BCBS of NC FEHBA Standard and Basic Operation plan for 2009 to get an idea of what the plan language may look like in this situation. According to the 2009 plan, it is the responsibility of the beneficiary to notify BCBS of any claim made against another party for compensation of an illness or injury where BCBS has made payment. According to their plan language, they are entitled to full recovery, and not subject to reduction for procurement. However it does express a willingness to grant a reduction at their discretion. It was not specified if the incident occurred in 2009, you would need to review the plan document for that year of enrollment. Hope this helps!
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