Lien Resolution – The Contract Does NOT always Control
Ingenix v. Ham, a Florida 2nd DCA opinion, applies 768.76(4) instead of the contract in a reimbursement action involving UnitedHealthcare (non-ERISA).
Category: Synergy InSights
Main Synergy InSights Blog Category
Outsourcing Lien Resolution: Happier Clients and a Better Bottom Line
Outsourcing of lien resolution needs for a law firm can make for happier clients and a better bottom line.
Something Useful from MSPRC – “Self-Calculated Final Conditional Payment Amount” Option
The MSPRC announced a new option to self calculate a conditional payment amount to submit for approval if the settlement is $25,000 or less.
Requesting the Fixed Percentage Option from the MSPRC for Conditional Payments – A Quick How To
MSPRC has provided instructions on how to elect the fixed percentage option for conditional payment resolution.
MSPRC Self Service Phone Feature & Other Important Changes
MSPRC to institute self service phone line.
CMS HQ Issues 1st Memo Regarding Liability Medicare Set Asides
On 9/29/11, CMS issued a memorandum indicating there is no need for a liability Medicare set aside and that its interests would be satisfied if the treating physician certifies in writing that treatment for the alleged injury related to the liability insurance has been completed as of the date of settlement.
CMS Issues Important Memo Regarding Liability Medicare Set Aside
In the first memo coming from CMS HQ regarding Liability Medicare Set Asides, Charlotte Benson, Acting Director Financial Services Group for CMS, gives us an exception to the need to create a set aside. According to the memo, a liability Medicare set aside isn’t necessary when the Medicare beneficiary’s treating physician certifies in writing that all of the care related to the claimed injury has been completed as of the date of the settlement.
Clients on Medicaid & Medicare Need Special Planning
Some individuals are dual eligible. In plain English, this means they qualify for both Medicaid and Medicare. In certain cases, a Medicare Set Aside/Pooled Trust Sub-Account may be necessary to preserve the dual eligibility.
Liability Medicare Set Asides: Region 6 Memo Provides a Little Clarity
CMS Region 6 issued a memorandum on liability Medicare set asides (“LMSA”) which has some useful information but has limited application outside of Texas, Oklahoma, New Mexico, Louisiana and Arkansas.