Evaluate the Benefits of the Primary Payer having Control in No-Fault and Workers Compensation Claims
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Identification: WED06
• Understand that If ORM is accepted then the defendant is the responsible debtor and will be held accountable for reimbursement of Conditional Payments
• Define the types of claims including personal injury protection, med pay policies, no-fault, homeowner’s policies, and workers compensation, to identify which Conditional Payment is owed by the debtor
• Report information regarding the claim through Mandatory Insurer Reporting to ensure CMS has all pertinent information
• Update ORM and ICDs on a quarterly basis to keep CMS informed of details of file
Identification: WED07
• Receive a Conditional Payment Notice generated by CRC in relation to the claim, or request a CPN If not automatically generated by the CRC to receive conditional payment information related to claim
• Dispute unrelated charges in the Conditional Payment Notice within 30-days
• Next Steps: Analyze BCRC’s request for payment, the Conditional Payment Demand,
• Prepare to pay within 60-days or appeal non-related Conditional Payments within 120-Days
Valuable Techniques when Dealing with Medicare Advantage and Prescription Drug Plans
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Identification: WED08
• Calculate new approaches to identify if a claimant has transitioned from traditional Medicare to Medicare Advantage or Prescription Drug Plan
• Connect with Medicare Advantage Plan or Prescription Drug Plan to determine if any payments have been made related to the claim
• Analyze payment log of items paid to make a determination if payments made are related and if not, to dispute errors
• Avoid being sued for double damages by ensuring your dispute with Medicare Advantage or Prescription Drug Plan is accurate and timely
Established Strategies when Working with US Department of Treasury and US Department of Justice
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Identification: WED09
• Understand process if no payment or appeal is made and examine the outcome of claim escalation of outstanding debt when referred to the US Department of Treasury
• Prepare to receive forceful communication from the US Department of Treasury Collectors, as they attempt to reclaim outstanding debt
• Strategies to resolve if debt remains unpaid, dealing with US Department of Treasury Offset Program
• Avoid being sued by the US Department of Justice for unpaid debts related to claim
Closing Remarks
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Identification: WED10
Speaker(s):