Subrogation recoveries for Medicare Advantage plans

In February, my colleague Liz Longo was featured as a webinar speaker for the National Association of Subrogation Professionals (NASP) on the topic “Medicare Advantage Plan Recoveries: Best Practices and Shifting Legal Tides.”  This topic has been evolving for more than 10 years as litigation and case law have disputed over the issue of whether the private cause of action for double damages under the Medicare Secondary Payer (“MSP”) Act provides Medicare Advantage (“MA”) Plans with the right to bring suit against primary payers.  The early rulings generally held that the secondary payer rights and recourses granted to the government under the MSP are different and do not apply to MA plans under the federal statute. As such, the only recourse available to MA Plans was to pursue reimbursement of those conditional payments through contract-based action in state courts.

The most significant hurdle is overcoming the fundamental misconception that MA Plans are private insurers.  In order to do so, MA Plans must be “all in” in the sense that they must adhere to all of the rules and regulations imposed upon an MA Plan. That being said, MA Plans must be sure to operate with caution in order to avoid compliance pitfalls.  As such, MA Plans must notify members of appeals rights, track grievances, maintain records of coverage investigations, and stay up-to-date on DX code directives in the CMS MSP Manual.

MA Plans must also utilize effective subrogation pursuit and recovery strategies. For example, ICD-10 and external property and casualty databases are very effective methods of leveraging technology for member outreach. The MA Plan may also track chronic conditions or review MSP files made available monthly by CMS. In doing so, MA Plans will address a primary concern, which is to avoid member abrasion during the identification and investigation processes.

If you would like to hear more about our point of view on MA Plan recoveries and best legal practices for subrogation, you can listen to our recorded webinar, available in its entirety for NASP members by clicking here.

 

Eddie PallSubrogation recoveries for Medicare Advantage plans
read more

Subrogation recoveries for Medicare Advantage plans

In February, my colleague Liz Longo was featured as a webinar speaker for the National Association of Subrogation Professionals (NASP) on the topic “Medicare Advantage Plan Recoveries: Best Practices and Shifting Legal Tides.”  This topic has been evolving for more than 10 years as litigation and case law have disputed over the issue of whether the private cause of action for double damages under the Medicare Secondary Payer (“MSP”) Act provides Medicare Advantage (“MA”) Plans with the right to bring suit against primary payers.  The early rulings generally held that the secondary payer rights and recourses granted to the government under the MSP are different and do not apply to MA plans under the federal statute. As such, the only recourse available to MA Plans was to pursue reimbursement of those conditional payments through contract-based action in state courts.

The most significant hurdle is overcoming the fundamental misconception that MA Plans are private insurers.  In order to do so, MA Plans must be “all in” in the sense that they must adhere to all of the rules and regulations imposed upon an MA Plan. That being said, MA Plans must be sure to operate with caution in order to avoid compliance pitfalls.  As such, MA Plans must notify members of appeals rights, track grievances, maintain records of coverage investigations, and stay up-to-date on DX code directives in the CMS MSP Manual.

MA Plans must also utilize effective subrogation pursuit and recovery strategies.  For example, ICD-10 and ISO are very effective methods of leveraging technology for member outreach.  The MA Plan may also track chronic conditions or review MSP files made available monthly by CMS.  In doing so, MA Plans will address a primary concern, which is to avoid member abrasion during the identification and investigation processes.

If you would like to hear more about our point of view on MA Plan recoveries and best legal practices for subrogation, you can listen to our recorded webinar, available in its entirety for NASP members by clicking here.

 

Eddie PallSubrogation recoveries for Medicare Advantage plans
read more

Post-conference wrap-up: 2015 NASP Conference

As a first-time attendee at the 2015 National Association of Subrogation Professionals (NASP) Conference, I wasn’t sure what to expect, but the education sessions, networking and entertainment were insightful and valuable.  So much so, that I’m already planning for the 2016 event.  Before sessions began, the NASP board of directors grabbed everyone’s attention with an amazing magician and illusionist, Mike Super.  Mike’s performance included members from the crowd and included everything from voodoo dolls to defying gravity.

After the kick-off entertainment, it was time to get down to business.  A variety of sessions were held throughout the day covering a breadth of subrogation topics including health, auto, property, product liability, or workers’ compensation.  I spent most of my time on the health subrogation track where multiple topics of interest were addressed including private causes of action by an Medicare Advantage Organizations under the Secondary Payer Act, ERISA analysis, and aggregate claims analysis (mass tort claims).

Day two featured a particularly interesting keynote address from Michele Stuart of JAG Investigations, an investigation specialist and expert in cyber-sleuthing. Her presentation was alarming and fascinating as she showed us how vulnerable our social media activity makes us to criminal activity and walked us through steps we can take to protect ourselves. She also showed us how we could use cyber-sleuthing strategies to inform our subrogation investigations. It is clearly a powerful and accessible tool that can be valuable for case identification and investigation.

Between the education sessions and ample networking time, I consider the NASP 2015 to be a huge success and look forward to working with some fresh ideas for my own subrogation clients and sharing insights with the Discovery Health Partners subrogation team.  Thanks to the NASP team for a great show and to the Discovery Health Partners team for their work and efforts on the show floor.

 

Eddie PallPost-conference wrap-up: 2015 NASP Conference
read more

Post-conference wrapup: 2015 NASP Conference

As a first-time attendee at the 2015 NASP Conference, I wasn’t sure what to expect, but the education sessions, networking and entertainment were insightful and valuable.  So much so, that I’m already planning for the 2016 event.  Before sessions began, the NASP board of directors grabbed everyone’s attention with an amazing magician and illusionist, Mike Super.  Mike’s performance included members from the crowd and included everything from voodoo dolls to defying gravity.

After the kick-off entertainment, it was time to get down to business.  A variety of sessions were held throughout the day covering a breadth of subrogation topics including health, auto, property, product liability, or workers’ compensation.  I spent most of my time on the health subrogation track where multiple topics of interest were addressed including private causes of action by an Medicare Advantage Organizations under the Secondary Payer Act, ERISA analysis, and aggregate claims analysis (mass tort claims).

Day two featured a particularly interesting keynote address from Michele Stuart of JAG Investigations, an investigation specialist and expert in cyber-sleuthing. Her presentation was alarming and fascinating as she showed us how vulnerable our social media activity makes us to criminal activity and walked us through steps we can take to protect ourselves. She also showed us how we could use cyber-sleuthing strategies to inform our subrogation investigations. It is clearly a powerful and accessible tool that can be valuable for case identification and investigation.

Between the education sessions and ample networking time, I consider the NASP 2015 to be a huge success and look forward to working with some fresh ideas for my own subrogation clients and sharing insights with the Discovery Health Partners subrogation team.  Thanks to the NASP team for a great show and to the Discovery Health Partners team for their work and efforts on the show floor.

 

 

Eddie PallPost-conference wrapup: 2015 NASP Conference
read more