Internal Medicare claims management is time consuming and error-prone because the Federal regulations are complex and continuously changing. It is virtually impossible for individual claim adjusters to stay on top of on-going changes, but non-compliance can result in financial penalties and negative publicity.
For most P&C insurers, 10% - 15% of personal injury claims involve a Medicare beneficiary. Because the number of such claims is relatively small, they are typically managed at the claim adjuster desk. Many P&C insurers have not created systems for managing the process and tracking their overall compliance status, including:
Flagship’s proprietary Medicare Risk Review (MRR) eliminates the unknowns and provides an analysis of insurer’s Medicare compliance status, including processing procedures, potential Conditional Payment rebuttal savings, plus any non-compliance issues and/or penalty exposure. Additionally, Flagship identifies Medicare training needs for claim professionals that include performance measures and best practices for accelerating settlements, minimizing litigation and avoiding penalties.
Flagship is keenly aware of the most common, as well as the infrequent, non-compliance issues. We understand how to protect clients’ financial resources by minimizing reimbursements, mitigating penalties, ensuring compliance and accelerating settlement. A Medicare Risk Review removes the uncertainties surrounding Medicare compliance, and completes the steps required to close a Medicare file and create a valid audit trail. At the conclusion of an MRR, Flagship provides client with a comprehensive Executive Summary showing audit findings, solutions and recommended actions.