blackburn group inc.

June 2012

The Medicare Implications for No Fault and Liability Insurance

Did you know that No-fault insurance is insurance that pays for health care services resulting from bodily injury or damage to property regardless of who is at fault for causing the accident? Types of no-fault insurance include but are not limited to automobile insurance, homeowners' insurance, and commercial insurance plans.

If it is determined that the no-fault or liability insurer will not pay "promptly" (within 120 days), providers and suppliers may submit claims to Medicare, and Medicare may make a conditional payment. However, when the proceeds from the no-fault or liability settlement become available, Medicare has a priority right of recovery. This means that Medicare collects the money it used for the conditional payment from the settlement before other providers and suppliers may collect from the settlement.

After the 120-day period, a provider or supplier may choose to bill Medicare conditionally. In a liability insurance situation, if the provider/supplier chooses to bill Medicare, they must withdraw claims against the liability insurer and any liens placed on the beneficiary's settlement. If they choose to continue their claim against the liability insurance settlement, they may not also bill Medicare.

A Quick Review Of The Medicare Secondary Payer Recovery Claim Process

In some recent updates to the Centers for Medicare & Medicaid Services (CMS) website it is a good time to review some of the critical components of the Medicare Secondary Payer Process which impact Liability and No-Fault Insurances and Workers' Compensation.

The background rules are that under the MSP laws (42 U.S.C. § 1395y(b)), Medicare does not pay for items or services to the extent that payment has been, or may reasonably be expected to be, made through a no-fault or liability insurer or through Workers' Compensation (WC). In addition, Medicare may make a conditional payment when there is evidence that the primary plan does not pay promptly, conditioned upon reimbursement when the primary plan does pay. As soon as the MSPRC has information concerning a potential recovery situation, it will identify the affected claims and begin recovery activities.

Insurers, beneficiaries, and representatives/attorney(s) are required to recognize the obligation to reimburse Medicare during any settlement negotiations with no exceptions.

What is My

It is the Official U.S. Government Website for Medicare that is dedicated to providing free, optional, and secure information to help Medicare Beneficiaries check their eligibility, enrollment, and other Medicare benefits. My is part of the web site. Medicare Beneficiaries can also access their claim information almost immediately after it is processed by Medicare and provide tips and suggestions on preventive health information 24 hours a day, seven days a week.

Click here for more information.

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