Did You Know: Medicare Recognizes Only 3 Types of Personal Injury Claims?

Posted by Kendell Gracey on Oct 15, 2014 2:38:00 PM

Insurance carriers and attorneys break down claims into dozens of different types and subtypes. However, Medicare doesn't take this approach.  Medicare only recognizes three distinct claim types: General Liability (GL), Workers’ Compensation (WC), and No-Fault (NF). 

This seems like it should make things simpler, but it really doesn't.  Instead, it's an excellent example of Medicare's “foreign language,” an issue that can cost insurance carriers significant amounts due to nothing more than misunderstanding what Medicare is saying.

Insurance carriers and attorneys handle myriad different personal injury cases in different ways:

  • Group Health Plans (GHP) - with various claims procedures for hundreds of plan levels, COB requirements, etc.
  • Non-Group Health Plans (Non-GHP) - including claims from motor vehicle accidents, slip-and-falls, etc. These come with various coverage stipulations for underinsureds, uninsureds, and third parties
  • No-Fault, including PIP and Med-Pay
  • Workers’ Compensation - with each state maintaining variant rules on workers’ comp claims processing and compliance.

Medicare recognizes only 3 types of personal injury claimsWhen the person involved in a personal injury claim is a Medicare beneficiary, these detailed definitions and nuances often don’t apply.  Each claim must be translated into one of the three distinct categories types Medicare recognizes, then processed according to their rules, or the primary payer is left financially exposed.

The situation is complicated further when a claim falls under more than one distinction.  For instance, if an auto accident is originally filed as a no-fault claim but later results in settlement to the Medicare beneficiary, Medicare requires both aspects of that claim to be handled separately.  As far as Medicare is concerned, the two are not related.  You would have to open the no-fault claim, and close that file. Then open the general liability claim and close that file.

An easy way to eliminate claims confusion

Here at Flagship Services Group, we focus on helping our clients properly process Medicare liability claims with 100% compliance.  The average claims adjuster may see a Medicare-related claim just once or twice a month, which makes it challenging to properly learn and keep up with the “language of Medicare.”  Flagship is fluent in this language.

What that means for you is simply this: If you want to ensure that you're not going to inadvertently leave your company open to fines, interest payments, and potentially double damages on Medicare-related claims, we can make that happen for you.

Let Flagship's Medicare experts locate, review, and properly process the 10-15% of your claims that involve Medicare beneficiaries.  Our total compliance guarantee means you have nothing to lose and everything to gain from working with Flagship Group.

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