Join GRG, May 28th for a special webcast designed to provide attorneys with a window into a realistic, practical conversation about the ethical obligations under the Medicare Secondary Payer Act that all parties face when negotiating the resolution of a liability or workers’ compensation claim. This conversation between a defense attorney (role played by Bruce Cranner) and a plaintiffs’ attorney (role played by GRG’s John Cattie) will highlight the concerns and issues facing DRI members and provide practical guidance about the action steps to be taken. Click here to register! 

The post DRI Webcast |The Ethics of MSP: A Conversation about Compliance – May 28th appeared first on Garretson Resolution Group.

Question: I have a client who is not a CMS beneficiary yet however we included a professionally prepared MSA into the agreement noting that CMS consent is not needed since she is not yet a CMS beneficiary. She will not be a beneficiary for another several years. Once she puts the funds into her self administered MSA account must we submit a copy of the workers comp settlement agreement to CMS immediately and must she submit the annual account expenditure form annually during the period prior to becoming a CMS beneficiary?

Answer: Thanks for the question! Medicare Set-Asides (MSAs) are a subject of conjecture for many attorneys, and a source of great concern for plaintiffs who fund them as part of resolving a workers’ compensation, automobile, liability insurance or no-fault claim. As a threshold issue, we note that your conservative take on the MSA issue will most certainly withstand any scrutiny on the issue going forward.

Now, with respect to your primary question, we see no reason for your client to forward materials to the Centers for Medicare and Medicaid Services (CMS) immediately upon funding the MSA. As things currently stand, CMS only tracks current Medicare beneficiaries in its database. CMS officials do not track MSAs for individuals who are not yet enrolled in Medicare. Thus, when the MSA is funded, there is no need to send either the settlement agreement or provide CMS with annual accountings. We would suggest your client maintain accurate records in the unlikely event that CMS, when your client becomes Medicare enrolled years in the future, wishes to review those at that time. Should you have any additional questions about this or other MSA issues, please contact us.

The post Medicare Set Asides & CMS Beneficiary Status appeared first on Garretson Resolution Group.

Question: As you have cautioned, Medicare Advantage Plans are becoming more assertive in recovering their payments. I have been contacted via telephone and email by a person at NexClaim Recoveries who says she is the Medicare recovery contractor for a Medicare Advantage Plan, VIVA Health. She claims that one of her plan members wants my insured to pay for medical expenses related to an accident that occurred on my insured’s premises. She states that the plan member told her what happened and that my insured was clearly negligent. Our inquiry does not support her supposition which is not the issue here at this point. Our dilemma is that the plan member has never made a liability claim or presented any related medical bills for payment under the general liability, no fault-med pay to our insured. 1. Under a premises liability-GL policy, does a Medicare Advantage Plan have a subrogation interest when no claim has been made by the potential claimant? 2. Is there a duty to pay a GL claim solely at the request of the subrogee, the entity who is assuming the legal right to attempt to collect a claim of another, subrogor?

Answer: Thank you for your question. Assuming that a Medicare Advantage Plan is claiming the same type of right as Medicare as provided under the Medicare Secondary Payer Act (MSP) we offer the following for your consideration with your legal counsel:

• Pursuant to the MSP, two things must occur before CMS’ priority right of recovery would ripen: 1) a primary plan or payer must accept responsibility (but not necessarily liability) for a beneficiary’s medicals; and 2) that responsibility must be evidenced in a judgment, a compromise for release or other means. Short of both things occurring, Medicare’s right does not ripen. Any payment made is made conditionally until a primary payer accepts responsibility.
• 42 CFR 422.108

It would seem that a claim is not reliant upon the beneficiary having made a prior claim but such a claim would require some showing of responsibility.

The post Medicare Advantage Plan Recovery appeared first on Garretson Resolution Group.

Once again, Garretson Resolution Group (“Garretson”) is pleased to work with members of the Alabama Association for Justice (“ALAJ”) and speak with ALAJ members at the ALAJ annual convention about lien resolution, Medicare compliance and Medicare Set-Aside issues.

This year, John Cattie, our Medicare Secondary Payer subject matter expert, will be on site to answer your questions personally. If you have a question for him, you can find him at the Garretson booth outside the ballroom during the sessions. If your colleagues and you are looking for a quieter setting to have a more detailed conversation, some firms are setting meetings with him to discuss internal compliance protocols so John can make suggestions as to how the law firm can become more efficient and more profitable as a business.

We invite you to do so as well so that you ensure one of your takeaways from the ALAJ annual convention is a formalized process for identifying and satisfying reimbursement obligations proactively in order to maximize your firm’s time, resources and profitability. To set an appointment, please call John directly at (704) 594-1778 pre-conference or email him at jcattie@garretsongroup.com.

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Question: I have a female client (DOB 10/23/1937) who sustained a minor hip fracture in March, 2009. She only treated for a few months (last treatment date was in May, 2009), and she has not received any medical treatment for that injury since May 2009. I do not believe that she was a Medicare beneficiary at the time of her injury, but I do know that Medicare made no conditional payments in connection with that injury. She is now a Medicare beneficiary. We have settled the case for $35,000. I am in the process of obtaining the final letter from Medicare (which I fully expect to state that there is no lien since no conditional payments were made).

Is this the type of case where a Medicare set aside may be necessary? The settlement is small and she has not treated for the injury in almost five years. I appreciate your thoughts.

Answer: While it may be unlikely in today’s environment (current Medicare Secondary Payer statute and final regulations) that an MSA would be required under such facts, best practices would dictate that the file has been documented to evidence that the issue was addressed at the date of settlement and the conclusions drawn were reasonable.

Actually, it is this type of case why we created our MSA Decision Engine. It allows a user to log into a secure web platform, answer a series of questions and arrive at a conclusion as to whether an MSA is warranted under those facts, the rationale for why such a conclusion was reached and then if an MSA is appropriate, the maximum amount for which the MSA would need to be funded. Priced at only $250 per file, it’s the lowest cost of compliance going today. If you are interested, click here to schedule your demo!

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The post Friday FAQ: Is a Medicare Set Aside Necessary in My Case? appeared first on Garretson Resolution Group.

Question: I have a situation with an ERISA self insured plan that has stop loss with very low attachment points —-operates like a 4K deductible per person. There are substantial medical bills in the case which were paid. At this point it appears those bills were not paid by the employer, but directly to the providers by an insurance carrier. The whole plan was set up following the new care health law and sold to a very small employer  as self insurance. Employer has reimbursement rights in plan for amounts they paid. If the insurance carrier paid the claims directly to the health providers, does that in anyway limit employers reimbursement rights or will it be treated as an irrelevant accounting issue? This is really operating as an insurance policy but I’m aware that the test is whether or not the employee has a claim against the carrier or the employer. The employer is in Virginia, where subrogation for PI claims is not allowed in insurance contracts.

Answer: As you may know, if a plan is self-funded or self-insured the ‘deemer clause’ of ERISA exempts these plans from state laws that “regulate insurance” within the meaning of the savings clause, and thus self-funded ERISA plans are exempt from state regulation insofar as that regulation relates to the plans. See FMC Corp. v. Holiday, 498 US 52 (1990). It is very common for self-insured groups to purchase stop loss insurance to protect themselves. Generally the underlying plan of benefits does not affect whether or not a plan would purchase stop loss insurance. As in your case, there is the potential for stop-loss coverage to blur the line between fully-insured and self-insured plans.

Stop loss coverage with a very low attachment point can appear very much like a conventional health plan with a high employee deductible. The NAIC has proposed raising the minimum thresholds for small groups in order to brighten the line between insured and self-insured plans to stabilize small group insurance markets but currently this practice is still accepted. In addition, historically the use of “stop-loss” insurance does not transform a self-funded plan into an insured plan. Bill Gray Enter., Inc. Emp. Health & Welfare Plan v. Gourley, 248 F.3d 206 (3rd Cir. 2001), American Medical Security, Inc. v. Bartlett, 111 F.3d 358 (4th Cir. 1997); and Goyen v. Vail Corp., 2011 WL 4479091 (D. Colo. Sept. 26, 2011). Courts have reasoned that stop loss arrangements do not change the fact that the ultimate liability to plan participants remains with the Plan.

It would appear that a self-funded ERISA plan, even with stop-loss coverage, is likely not subject to state law defenses that may otherwise be available in reducing a plan’s reimbursement interest. Additionally, based on the recent ruling by the Supreme Court, the plain language of a health plan will control the resolution of any lien unless the plan is silent as to traditional equitable doctrines. See U.S. Airways, Inc. v. McCutchen, 2013 WL 1567371 (April 16, 2013). However, there is one potential exception which could be argued under the circumstances you present.

In some cases an attachment point could be set very low and the Plan could be attempting to function as and enjoy the benefits of a self-funded plan under ERISA when in fact it is really an insured plan. Such examples would include a specific attachment point of $500 (individual claim) or $25,000 for an aggregate attachment point (total benefits paid for all participants). In such cases, a court could arguably look to the substance of the Plan rather than its alleged form. See Brown v. Granatelli, 897 F.2d 1351, 1355 (5th Cir. 1990). In determining whether a stop-loss Plan is truly self-funded or merely illusory, a court could look to the loss experience and how often the stop-loss coverage has applied. I don’t know that the fact the carrier made payments will make a difference but it certainly wouldn’t hurt your argument.

John Cattie
MSP Compliance Attorney
jcattie@garretsongroup.com

The post How to Handle ERISA Self-Insured Plans with Stop Loss Coverage and Low Attachment Points appeared first on Garretson Resolution Group.

Heading to the AAJ Summer Annual Convention this weekend? We’ll be there at booth #706 so be sure to come by and talk liens and medicare set asides with us! We’ll have our Subject Matter Experts there to answer any questions you may have, PLUS you’ll have a chance to win a free Kindle Fire. We’re also doing a special on our CLE Center courses for the AAJ Annual Convention. Enter the code below and you’ll receive 50% off all CLE course offerings in our Learning & Resource Center. What better time to fire up that iPad and get in a CLE than on your trip to Baltimore? See you at booth #706! 

Click here if you still need to register for the AAJ Annual Convention!

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Question: I was an attendee at a recent conference where an attorney from GRG spoke. He talked about factors you should consider when deciding whether a client needs an MSA or not, and documenting the file if you decide an MSA is not required. In making that decision, does the amount of No Fault coverage a plaintiff has in a motor vehicle accident case effect whether an MSA is necessary?

I am currently handling a matter where the plaintiff has significant No Fault coverage left, as well as an additional $25K of OBEL coverage and APIP coverage. The plaintiff will require a surgery in the future, but at this point has delayed having it due to circumstances regarding the care of a spouse. The No Fault carrier has indicated that they will pay for the surgery and all subsequent follow up appointments and therapy when the plaintiff decides to have the surgery.

The underlying bodily injury limits in this case I mentioned are only $50K. The client is concerned that any net proceeds he/she may receive will be eaten up by an MSA. However, in thinking about this case I was not sure if an MSA would be necessary in light of the available No Fault coverage. Any insight that you can provide on this would be appreciated.

Answer: At the end of the day, the Medicare Secondary Payer (MSP) statute (42 U.S.C. §1395y(b)(2)) is all about burden shifting. By that, I mean to say that the statute is in place to ensure that the party responsible for a beneficiary’s injuries is paying those bills such that the federal government (and the American taxpayer) are not footing that bill. This means that the beneficiary takes a certain amount of settlement proceeds (affirmatively identified as opposed to proceeds intended for past medicals, wage loss, non-economic damages, etc) and uses those first before Medicare gets billed. Under that rubric, a beneficiary does not rule afoul of the MSP statute if an entity other than Medicare is paying for future injury-related care. In your fact pattern, it sounds as though there is ample No-Fault coverage available which would pay first before Medicare is asked to pay. So long as that coverage continues to exist and is available to make those payments going forward, Medicare would not be asked to pay. Thus, no one would run afoul of the MSP statute with respect to future medicals.

We would be happy to formalized this guidance for the file in the form of an MSA Evaluation Letter which you could rely on to document the file and evidence compliance on this issue going forward. Let us know if we can assist!

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Question: I have a Workers’ Compensation claim with a 78 year old claimant who is contemplating a $130K settlement of which $6904 of it is the Medicare set aside (MSA) to be be paid out in lump sum. Claimant self administers. He realizes he must spend down and account for his medical expenses. The concern this elderly gentleman has is that he is afraid Medicare will take the amount not yet spent down in this account should he die in the future. Is that true? Also, can the self administered account have a spouse’s name on it?

Answer: Thank you for your question. Medicare set aside proceeds are to be used to pay for a beneficiary’s future injury-related care otherwise covered by Medicare. Should the beneficiary pass away prior to those proceeds being exhausted, they would pass to the named beneficiary on the MSA account. If there is no named beneficiary, then they would pass in accordance with state intestacy statutes. If you would like more information about how they can set up this self-administered MSA, please visit our MSA administration service at www.affiancepartners.com.

The post What Happens to Medicare Set Aside Proceeds Upon a Claimant’s Death? appeared first on Garretson Resolution Group.

Question: My client has a claim for a dog bite. She is covered by Blue Cross Blue Shield as a retired teacher and has an LPPO Plan on behalf of Medicare. Nothing shows up on Conditional Payment Online for her medicals for Medicare. Do I need to call BC/BS? Is this a Medicare Part C Plan?

Answer: As your client is both Medicare enrolled and is enrolled in a private health insurance plan, and the federal government is telling you that it has not paid anything for conditional payments on behalf of its beneficiary, it’s a good bet that the private plan is the one that has been paying the bills to date. However, to understand with certainty the plan’s rights and your client’s obligation to reimbursement that plan for past medicals, a review of the plan language is critical. Our private/ERISA group can assist you further in this matter.

Visit http://web.garretsongroup.com/Private-Health-Insurance-ERISA-Hospital–Provider-Liens for more information.

The post Q&A: Private Plan Rights & Reimbursement Obligations appeared first on Garretson Resolution Group.

On August 19, 2014, the Centers for Medicare and Medicaid Services (“CMS”) released a policy alert regarding its December 5, 1980 policy exception to reimbursement and reporting obligations under the Medicare Secondary Payer (“MSP”) statute. According to the September 30, 2011 Alert, Medicare will not assert a recovery claim against liability insurance (including self-insurance) settlement, judgment, award, or other payment, or enforce mandatory reporting rules, when the Date of Incident (“DOI”) occurred before December 5, 1980 and all three parts of the policy exception criteria as outlined in the September 30, 2011 Alert are met.

CMS announces two new changes in the August 19, 2014 Alert. First, CMS will now accept the most recently amended operative complaint when determining a claimant’s reimbursement obligations under the MSP statute, and reporting obligations under Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (“MMSEA”). Prior to this Alert, CMS had stated that injuries that were claimed, pledged, alleged, or released in any version of the complaint were to be considered in determining whether a claimant should be exempt or non-exempt from reimbursement and MMSEA Section 111 reporting. With this new change, CMS will now accept the most recent amended operative complaint (or comparative supplemental pleading), disregarding all previous versions, when the following two criteria are met:

1. The amended complaint does not shift the burden to Medicare by removing any claim for medical damages, care, items and/or services; and
2. The amended complaint does not contradict governing MSP policy, law, or regulations.

In the case of a court-ordered amended complaint, CMS will defer to the court order, even if it limits Medicare’s recovery claim, as long as the criteria described in the August 19, 2014 Alert are met, and the court order does not contradict the governing MSP laws, regulations, or policies. In sum, the CMS Alert confirms that where a complaint (or comparable supplemental pleading) contains broad language concerning exposure, but evidence exists that the last date of exposure occurred before December 5, 1980, where the complaint is amended to reflect the facts – and done so prior to settlement – the case will be non-reportable and will not trigger any reimbursement obligations for the settling parties.

The Alert’s second change requires that if there are multiple defendants, then all defendants’ cases must meet the December 5, 1980 MSP exemption criteria for any and all defendants to be exempt from their MMSEA reporting obligations.

Prior to the August 19, 2014 Alert, in a multiple defendant scenario, as long as a claimant met the exemption criteria for a single defendant, the RRE for that defendant was not required to report. In a three defendant scenario (Defendants A, B, and C), if a claimant met the MSP exemption criteria for Defendant A, but did not meet the criteria for Defendants B and C, Defendant A would be exempt and Defendant B and C would still be required to report the claimant to Medicare. If the defendants had joint and several liability for the settlement, judgment, award, or other payment, all defendants (A, B, and C) would be required to report.

As a result of the August 19, 2014 Alert, in a multiple defendant scenario, a claimant must meet the December 5, 1980 MSP exemption criteria for all defendants in order for all defendants to be exempt from MMSEA reporting. For example, in a three defendant scenario (Defendants D, E, and F), if a claimant meets the MSP exemption criteria for Defendant D, but does not meet the criteria for Defendants E and F, all defendants will be required to report the claimant to Medicare. The only way for Defendants D, E, and F to be exempt from reporting to Medicare is if a claimant meets the criteria for MSP exemption for all three defendants.

The Garretson Resolution Group continues to provide industry insight to CMS, as well as monitor for developments at CMS, and will report future developments to the settlement community. For more information about this announcement and other MSP compliance services (including conditional payment reimbursement, MSA services and MMSEA Section 111 reporting), please visit www.garretsongroup.com.

To view the Alert as posted by CMS, please click here.

The post Client Alert: CMS Issues Policy Alert Regarding 12/5/80 Reimbursement and Reporting Obligations appeared first on Garretson Resolution Group.

Garretson Resolution Group (GRG) is looking forward to the National Workers’ Compensation Defense Network (NWCDN) Fall Conference in Chicago in September. At this same event a few years ago, you likely heard John Cattie, our MSA Subject Matter Expert and nationally known speaker on the topic, talk about how an employer or insurance carrier could minimize or extinguish its reimbursement exposure under the Medicare Secondary Payer (MSP) Act by appropriately identifying proceeds for non-medicals versus medicals within the final award. Recently, CMS has confirmed that such actions are an appropriate manner by which to consider and protect its future interest. Click here to read the Practice Tip John drafted discussing that recent development.

GRG invites you and the clients you invite to attend the NWCDN Fall Conference to discuss these topics with John in person during the conference. The discussion may radically change your client’s perception about MSAs and how their current compliance protocols may not align with CMS’ stated preferential processes. John’s discussion about these concepts with you and your client may help build the collective confidence that you are utilizing – or on the path to utilizing – best practices. To set an appointment with him, you can call him directly at (704) 594-1778 or email him at jcattie@garretsongroup.com. We hope to see you in Chicago!

Click here to register for the conference.

The post GRG Speaking at the National Workers’ Compensation Defense Network Fall Conference appeared first on Garretson Resolution Group.

Recently, the Centers for Medicare & Medicaid Services (CMS) issued an alert related to Workers’ Compensation Medicare Set Asides (WCMSAs). CMS announced a future enhancement to its WCMSA Portal (WCMSAP) which will allow users to enter prescription medication information directly into the WCMSAP. With this enhancement, users of the WCMSAP can input and calculate the prescription medication component to a WCMSA. With the government’s assistance, users will be able to calculate a WCMSA more accurately from the start, as many in the WCMSA industry have received an increase number of “counter-higher” letters from CMS where the WCMSA obligation was calculated incorrectly by the parties and/or their MSP compliance experts. This enhancement will be made available to users as of October 6, 2014.

CMS expects to provide more information prior to the October 6, 2014 enhancement date which may include images of the WCMSAP prescription medication pages of the site and other details. For more information, please see : http://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Workers-Compensation-Medicare-Set-Aside-Arrangements/Whats-New/Whats-New.html.

CMS continues to provide clarity around WCMSAs and what its expectations are of the parties resolving workers’ compensation claims. The WCMSAP enhancement is the most recent, but by no means the final piece to the future medicals puzzle. Garretson Resolution Group will continue to inform you of those changes as well as provide cutting edge technology solutions which allow our clients to fully protect Medicare’s future interest while minimizing or extinguishing their own exposure on WCMSA and other Medicare Secondary Payer compliance issues. For more information about how to accomplish that, call John V. Cattie Jr. at (704) 594-1778 or email him at jcattie@garretsongroup.com.

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Q&A: I’m familiar with GRG’s work in the mass tort world, but how does GRG handle healthcare lien resolution in individual or “single event” cases? In the Single Event context, there are two ways to refer your cases to GRG for lien resolution and MSA work:

1. on a case-by-case basis, whereby cases are evaluated for healthcare obligations as they’re sent to GRG from your firm; or
2. through an automatic system whereby every case your firm handles undergoes a screening for healthcare liens and potential MSA requirements.

While a firm and its clients still realize the benefits of outsourcing lien and MSA work to GRG when referring cases one at a time (i.e. in a “Case Referral” arrangement), the ideal method is to establish a system for ensuring compliance in every single case. These arrangements are known as GRG Compliance Programs. By establishing a Compliance Program with GRG, your firm receives the benefit of having a comprehensive, integrated, firm-wide solution that systematically addresses past and future cost of care obligations in every case. Plus, Compliance Program clients can take advantage of preferred pricing and payment terms. GRG handles healthcare lien obligations in single event cases for thousands of firms across the country. To learn more, schedule a call with us at a time that’s convenient for you.

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When it comes to dealing with healthcare liens and Medicare Set Asides, every personal injury law firm has a clear decision to make: address liens internally or engage a third-party service provider.

Firms may choose to dedicate the time, money and resources to “build” an internal system. Alternatively, they may choose to “buy” a solution – in other words, outsource this work to an experienced service provider. But no matter which route a firm chooses, one thing is certain: its clients must come first. A clearly-defined strategy for resolving healthcare liens/reimbursement claims and addressing the question of whether a MSA should be considered in each case is critical to protecting clients and ensuring complete compliance.

Today, we’re excited to bring you our latest eBook, Build It vs. Buy It: How Outsourcing Healthcare Lien Resolution & Medicare Set Aside Administration Could be the Best Decision you Make for your Clients and your Firm.

Here we explore the considerations of outsourcing vs. handling healthcare liens and MSAs in-house. We also discuss the current state of healthcare reimbursement rights, what it takes to process a lien, and the reasons law firms look to outsource this function. The ethics of billing lien resolution fees as case expenses as well as tips for choosing a service provider are also covered.

Over the next several weeks, this blog series will highlight a few of the key concepts from the eBook. Click below to download the complete eBook or subscribe to GRG’s blog to ensure you see the entire series. If you’d like to speak with someone about your firm’s strategy to handle liens and MSAs, feel free to schedule a call at a time that’s convenient for you.

The post Outsource Lien Resolution and MSA Administration or Build a DIY Infrastructure? appeared first on Garretson Resolution Group.

Will you be attending Mass Torts Made Perfect in Las Vegas this week? We’ll be at booth #37 and our very own Libby Vish will be speaking at the Business of Law Seminar on Wednesday. Click here to view the seminar schedule. 

If you’d like to meet with us regarding your current projects be sure to stop by our exhibit booth or click here to drop us a line. Simply complete the form below if you’d like to schedule time with us!

The post See You at Mass Torts Made Perfect! appeared first on Garretson Resolution Group.

If you’ve personally resolved healthcare liens for a client, you know that the process can be a bit of a maize. First, you must figure out what federal, state, and/or private/ERISA healthcare coverage paid for your client’s treatment. In a perfect scenario, it’s straightforward – your client provides you with an organized file containing copies of all medical bills and documentation for each payment. But let’s face it: usually, it’s not this simple. Plaintiffs don’t have a complete record of bills and payments. Many will have multiple healthcare liens associated with their recovery. Some don’t know which providers paid for which treatments. So counsel is left to try and figure it all out; at the end of the day, you are responsible for seeing that all healthcare liens are thoroughly addressed before your case can be finalized. 

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For example, a plaintiff is covered under her employer’s healthcare plan when she is permanently disabled in a car accident. After her injury – but before the settlement is finalized – she loses her employer-sponsored coverage and enrolls in Medicare and Medicaid. The plaintiff then becomes a “dual beneficiary” when Medicaid kicks in to cover the coinsurance and deductible for her Medicare coverage. Consequently, the attorneys are now responsible for addressing the private insurer, Medicare, and Medicaid liens in this case. One pitfall attorneys encounter when dealing with claimants who “only” have Medicare coverage is thinking that resolving liens will be straightforward. In fact, they may end up trying to resolve three separate healthcare reimbursement claims in the end, as Medicare plans could be outsourced to multiple administrators for different components of coverage: Medicare Part A, Part B, Part D & Medicare Advantage Organizations (Medicare Part C plans). Each benefit structure has unique plan language governing reimbursement and separate protocols to develop, offset, compromise, and finalize claims. A detailed checklist for resolving Medicare, Medicaid, and private liens and determining the propriety of MSAs can be found in our eBook, Build It vs. Buy It: How Outsourcing Healthcare Lien Resolution & Medicare Set Aside Administration Could be the Best Decision you Make for your Clients and your Firm. In short, counsel must check off the following boxes in each case:

• Determine the parties’ affirmative obligation to notify healthcare plans
• Assess the healthcare plans’ right of recovery under the facts at hand
• Audit and analyze all reimbursement claims to determine accuracy and to “carve out” items unrelated to injury/settlement
• Pursue relevant administrative or legal remedies, such as damage allocation, waivers, and compromises, if needed
• Determine whether it’s necessary to establish a MSA

What’s the bottom line? Each firm has a clear decision to make: address liens internally or engage a third-party service provider. Healthcare liens are complex and ignoring them is not an option. Law firms that don’t already have procedures in place to address healthcare liens need to develop a clearly defined strategy to ensure their clients’ liens and overall claims are properly handled.

The post What makes healthcare lien resolution so complicated and what does it take to resolve a healthcare lien? appeared first on Garretson Resolution Group.

In the last post in our Build It vs. Buy It blog series, we discussed some of the complications attorneys encounter in trying to handle their clients’ healthcare liens on their own. Today, we’re sharing a case study from our eBook that’s tells how one attorney eased his anxiety after outsourcing his firm’s lien resolution work to GRG.

For one personal injury attorney, the decision to become a GRG Compliance Program client could not have been easier. With four associates, 50 staff members, and an annual caseload of approximately 300 cases, he found himself overwhelmed one day while reading about the compliance obligations for Medicare liens, and the penalties attorneys could face in failing to properly address those issues. How could he ensure that his clients were getting the needed level of service, and that Medicare’s recovery rights were properly addressed in each and every case?

The answer came when he connected with a GRG Client Development Manager. The attorney was familiar with GRG’s work in the mass tort world and wanted to learn how GRG could help him better serve his clients in individual (single event) cases. After hearing about what GRG’s Compliance Program offered, the attorney knew he had found the solution for his clients and his practice overall.

First, however, he did his homework. The attorney sat down with GRG and analyzed the outsourcing agreement in detail. He reviewed the fee schedule, fee terms and specific language in the agreement. The attorney gave GRG accurate estimates of his anticipated annual case volume, which enabled his dedicated GRG client service team to properly plan for the work.

To get started, he instructed his staff to pull all the firm’s active cases involving Medicare beneficiaries. He contacted all of his clients with potential Medicare claims and obtained each one’s consent to outsource lien resolution work to GRG. His staff sent GRG all the information needed, including signed consent and proof of representation forms.

Today, GRG’s client education form and healthcare lien authorizations are included in the firm’s new client sign-up package for their clients’ review and signature. GRG seamlessly takes on each new case involving a Medicare beneficiary.

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At the end of the day, the attorney can rest easy knowing that each one of his cases is stamped with GRG’s healthcare compliance seal of approval and his clients are better served because of it. He no longer worries about missing an obligation and jeopardizing his clients’ health care benefits.

The post Case Study: How One Law Firm Found Relief in Outsourcing appeared first on Garretson Resolution Group.