blackburn group inc.

April 2011

Medicare Bill H.R. 1063 - What Does It Mean To You?

MARC, the Medicare Advocacy Recovery Coalition has recently drafted the Strengthening Medicare and Repaying Taxpayers (SMART) Act introduced into Congress March 14, 2011. The purpose of H.R. 1063 is to streamline the Medicare process. MARC supports Medicare's need to be reimbursed for Conditional Payments while simplifying the payment process and providing all parties much needed certainty. Some key provisions of H.R. 1063 include: A requirement that Medicare provide the Conditional Payment to the requesting party within 65 days of a request; A mechanism to establish a threshold below which Medicare recovery efforts would not ensue; and A provision that the current Medicare and Medicaid SCHIP Extension Act Section 111 Mandatory Insurer Reporting penalties of $1,000 per claim per day be discretionary and based upon the Responsible Reporting Entity (RRE's) willful failure to report pursuant to that section.

If A Beneficiary Passes Away Before The Medicare Set Aside Arrangement Is Completely Exhausted, What Do You Do?

According to CMS, when there is an unused amount in the beneficiary's Medicare Set Aside arrangement, it may be disbursed pursuant to state law, once Medicare's interests have been satisfied. In addition, there are always other provisions that are recommended as part of specific Claim Settlement Solutions Strategies like Special Needs Trusts and Estate Planning. Call us to help guide you through the process!

What to Know About Conditional Payment Letters for Liability Insurance, Workers Compensation Insurance, Self Insurance, & No Fault Claims

A Conditional Payment Letter (CPL) is a payment that Medicare conditionally makes for services where another payer may be responsible. It is conditional because it must be repaid to Medicare when a settlement, judgment, award or other payment is secured. A Final Demand Letter is generated by Medicare Secondary Payer Recovery Contractor (MSPRC), upon request, once a case has settled. Payment is due within 60 days of the date of the demand letter or interest/penalties will accrue. Are you receiving your Conditional Payment and Demand Letters before negotiating a final settlement?

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