PMSI Launches MedicareInsights.com Blog
PMSI Launches MedicareInsights.com Blog PMSI launches a new blog, MedicareInsights.com — the only blog integrating medical, pharmacy, claims and legal expertise to deliver insights to help workers’ compensation and liability payers navigate the ever-changing Medicare Secondary Payer (MSP) landscape. The blog will feature the latest on industry issues such as Mandatory Insurer Reporting (MIR) and prescription drug allocations for Medicare Set-Asides (MSAs), as well as other critical settlement-related resources.(PRWEB) July 14, 2011
WHAT: PMSI launches a new blog, MedicareInsights.com — the only blog integrating medical, pharmacy, claims and legal expertise to deliver insights to help workers’ compensation and liability payers navigate the ever-changing Medicare Secondary Payer (MSP) landscape. The blog will feature the latest on industry issues such as Mandatory Insurer Reporting (MIR) and prescription drug allocations for Medicare Set-Asides (MSAs), as well as other critical settlement-related resources. MedicareInsights.com also encourages collaboration among clients, partners, and industry contacts through the ability to comment on posts or submit questions via the “Ask the Experts” feature.
WHO: PMSI Settlement Solutions pioneered Medicare Set-Aside (MSA) allocations in 2001 and was the first company to integrate Medicare Set-Asides with a comprehensive pharmacy and clinical program to mitigate costs related to claims settlement. PMSI has been at the forefront of Mandatory Insurer Reporting (MIR) compliance, and is considered a leading provider of MSP compliance for both the workers’ compensation and liability markets. Our best-in-class services and technology solutions help payers navigate the shifting settlement environment and settle cases effectively.
WHY: By accessing and subscribing to MedicareInsights.com , individuals will be able stay current on issues affecting Medicare Secondary Payer (MSP) compliance and have convenient access to general tools and resources related to Medicare Set-Asides. It also provides a forum for industry professionals to express their thoughts across the medical, pharmacy, claims and legal spectrum.
HOW: To visit and subscribe to the blog, go to http://www.MedicareInsights.com .
About PMSI: Founded in 1976, PMSI is a leader in developing solutions to control the growth of medical costs in workers’ compensation. As one of the nation’s largest and most experienced companies focused solely on workers’ compensation, we deliver proven solutions for cost containment across the claims lifecycle. PMSI’s Pharmacy, Medical Services and Equipment, and Settlement Solutions products deliver quantifiable results and improve the quality of care for injured workers. We provide our customers with the innovation, focus, expertise, analytics and technology needed to successfully deliver workers’ compensation benefits.
Medicare Secondary Payer - News
PMSI launches a new blog, MedicareInsights.com — the only blog integrating medical, pharmacy, claims and legal expertise to deliver insights to help workers' compensation and liability payers navigate the ever-changing Medicare Secondary Payer (MSP)
However, as the secondary payer, Medicare is required to pay for a Medicare beneficiary's care if the primary payer is not expected to pay promptly. Medicare's payments are conditional payments, subject to reimbursement to the appropriate Medicare
Generally, Medicare is the "primary payer" for health claims. If a beneficiary has other insurance, that insurance may fill in all or some of Medicare's gaps. However, the Medicare Secondary Payer program identifies specific conditions under which
Mandatory Medicare Secondary Payer reporting remains an overly broad and uncertain burden that needs to be clarified, property/casualty insurers said in response a US Department of Health and Human Services request for comments.
The regulations were imposed by CMS to implement the Medicare Secondary Payer Act (MSP) provision of a 2007 law. The law is a reporting mandate designed to ensure that Medicare remains the secondary payer when a Medicare beneficiary has medical
Beware of The Medicare Secondary Payer Act When - Workers Comp Kit ...
Employers need to be aware of the risk involved when an injured employee is also a Medicare or Medicaid beneficiary. Any expense paid by CMS for workers compensation-related medical care can be recovered from the self-insured employer, even if the workers compensation claim has been settled and closed. Therefore, if the injured employee is collecting Medicare benefits for non-work-related medical expenses, the self-insured employer should verify that CMS has been paid for any medical cost they have incurred due to work-related medical care.(WCxKit) In routine workers compensation claims, the employee treats with the medical provider and the medical provider submits the medical bills to the claims office or medical fee schedule reviewer where they are processed and paid. The workers compensation claims where the self-insured employer gets into trouble are long-term claims where the employee is treated by more than one medical provider and often for both a work-related injury and non-work related medical issues. It is almost a certainty that sooner or later the employee gives his/her Medicare or Medicaid card to the workers compensation medical provider, resulting in CMS paying for the medical care. It is not enough to accept the employee's statement they have not used their Medicare benefits or they have reimbursed Medicare or will reimburse Medicare. All known workers compensation medical bills should be paid directly to the medical provider. When settling the claim with an employee who has Medicare or Medicaid benefits, as a part of your pre-settlement procedure, run a query with CMS. Guidelines on how to submit a query are a part of the CMS Secondary Payer Act guidelines published on the CMS website: It will not do the self-insured employer any good to include wording in the Compromise and Release, or Release and Settlement Agreement that the claimant will be responsible for the repayment to CMS for any medical expenses they have paid as a result of the workers compensation claim. The agreement is between you and the employee. CMS is not a part of the agreement. They can still enforce their recovery rights and will do so. It is also much easier for CMS to go after the deep pockets of the employer than the employee who has already spent the money that was supposed to cover any medical bills that were not previously paid by the workers compensation insurance.
El Paso attorneys -- contact us about a special discount at Medicare Secondary Payer seminar on 7/29. dblackaby@mspeducation.com
Medicare Secondary Payer seminars next week in Albuquerque (7/28) and El Paso (7/29). Register at .
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