Social Security Number Removal Initiative (SSNRI) now known as “New Medicare Cards”

Posted by Gina Cox on Jul 28, 2017 8:00:00 AM

The Centers for Medicare & Medicaid Services (CMS) announced this week that the Social Security Number Removal Initiative (SSNRI) will now be known as “New Medicare cards.” Regardless of what the program is called, the bottom line is that the old Social Security Number based Health Insurance Claim Number (HICN) will be replaced by a new Medicare Beneficiary Identifier (MBI). This is not exactly new news as the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 required CMS to remove Social Security Numbers from all Medicare cards by April 2019 and CMS announced the upcoming transition earlier year.

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Topics: CMS, Compliance, Claims Processing

What is an Intent to Refer Letter from Medicare and How You Should Handle It?

Posted by Brian Cox on Aug 16, 2016 3:43:28 PM

As the No-Fault and Workers Compensation process with the Commercial Repayment Center (CRC) continues to unfold, many P&C Carriers are now receiving the next round of automated notifications from Medicare regarding outstanding conditional payments. For many, this is the first time they have seen an Intent to Refer letter.

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Topics: Claims Processing, CRC, medicare compliance

Never Leave Medicare Compliance in the Hands of a Claimant’s Attorney

Posted by Brian Cox on Jul 22, 2016 2:46:02 PM

In over 5 years working exclusively within the complex Medicare compliance industry, we’ve heard a number of alarming stories from clients who decided to work with us after running into costly and frustrating issues that could have been avoided.

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Topics: Claims Processing

What Do You Do When You Get a Letter from Medicare?

Posted by Brian Cox on Feb 5, 2016 2:08:39 PM

If you’ve ever gotten a letter from Medicare, you’ve probably found yourself asking two basic questions:

  • What does this letter mean?
  • What am I supposed to do with it?

Both are good questions.

Since it sometimes feels like Medicare is speaking a foreign language full of three-letter acronyms, we’re here to translate and help you make sense of the letters you receive.

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Topics: Compliance, Beneficiaries, Claims Processing

Interpreting the “Final Rule” on the Conditional Payment Appeals Process

Posted by Kendell Gracey on Jul 23, 2015 6:00:00 AM

On December 27, 2013, Centers for Medicare and Medicaid Services (CMS) issued a Proposed Rule regarding how “applicable plans” like P&C insurance, workers’ compensation, and no-fault insurance, could appeal conditional payments demanded by Medicare.

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Topics: Claims Processing

3 Ways P&C Insurers Can Use Data to Improve Medicare Claims Reporting

Posted by Kendell Gracey on Apr 17, 2015 6:00:00 AM

The advent of new and improved technology for data collection is continually improving efficiencies for P&C Insurers. However, you still have to know how to use and analyze this data to improve Medicare reporting and compliance.

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Topics: Compliance, Claims Processing

3 Absolute Must-Dos When Attempting Medicare Compliance

Posted by Kendell Gracey on Mar 5, 2015 8:00:00 AM

We've worked with all sorts of clients over the years: large and small, public and private. One thing we run into over and over again is that these companies simply do not understand the level of risk they are exposed to when it comes to Medicare compliance.

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Topics: Claims Processing

Need to Resolve a Medicare Lien? Start With These 3 Steps

Posted by Kendell Gracey on Feb 5, 2015 8:30:00 AM

Resolving a Medicare lien can be costlier and more time consuming than most other claims of similar value and complexity. Part of the reason for this is the relative rarity with which your claims adjusters process these claims. Part of it comes from the fact that Medicare regulations are constantly evolving. And, of course, the intricacies of properly reporting and filing these claims simply take a long time to complete.

We've established a simple, three step process for effectively resolving Medicare liens - and really, handling all Medicare compliance issues your company is faced with - quickly and efficiently.

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Topics: Compliance, Claims Processing

How Flagship Services Group Helps Claims Adjusters – Part Two

Posted by Kendell Gracey on Nov 27, 2014 3:19:00 PM

This is the second in a two-part blog series involving the day-to-day role of a claims adjuster at the average P&C insurance carrier and how Flagship Services Group can make that day easier and more rewarding.  In the last post, we looked at some potential pitfalls the average claims adjuster does not want to deal with.  In this post, we'll discuss how these pitfalls are avoided.

As we noted in the previous post, the average claims adjuster at a mid-size to large P&C insurance carrier has a heavy case load and a lot of stringent requirements and KPIs keeping them on their toes. 

We were introduced to Bob, a P&C staff claims adjuster who just opened up a new file to find it's one of those dreaded Medicare reimbursement cases.  The claimant is a Medicare beneficiary who was injured in a motor vehicle accident and was in the hospital for several days.  In addition, he has ongoing physical therapy and follow-up medical bills in the mix.  Medicare has already paid for the hospitalization and a Conditional Payment Letter is on its way.

Now, Bob only sees one or two of these types of claims every month, in among as many as 200 claims he may touch in that same amount of time.  As a result, he's not completely comfortable with all the regulations involved, and he knows it's going to take a lot of time to research it and get that all straight before he can proceed with confidence.  

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Topics: Claims Processing

How Flagship Services Group Helps Claims Adjusters – Part One

Posted by Kendell Gracey on Nov 20, 2014 2:25:00 PM

This is the first in a two-part blog series involving the day-to-day role of a claims adjuster at the average P&C insurance carrier and how Flagship Services Group can make that day easier and more rewarding.  In this post, we'll look at some potential pitfalls the average claims adjuster is not going to want to deal with.  In the next post, we'll discuss how these pitfalls are avoided.

The average claims adjuster at a mid-size to large P&C insurance carrier – let's call him Bob – has myriad tasks to handle throughout a given day.

Bob's Busy Day

Bob starts the day listening to 14 voicemails that came in since he left the previous day.  Three are from one particularly tenacious and obnoxious lawyer who enjoys trying to bully adjusters with crude language and a lot of bluff and bluster. The rest are from various claimants, attorneys, and other sources he's been playing phone tag with for days now.

Next, over a cup of not-so-good coffee, Bob reviews his inbox to find two new files in his queue.  This puts his total case load at 134 – not the worst he's seen, but right up there.  He sighs and pulls out a Post-It note to remind himself to make the obligatory contact call on each of these new claims before he leaves today since the 24-hour service standard will have expired before he gets in tomorrow.

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Topics: Claims Processing