Integrating Medicare Compliance with Claim Management

The Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) has created new reporting obligations for businesses. The federal government, through its increasing enforcement of the Medicare Secondary Payer Act (MSPA), has demonstrated an objective to avoid or recover all Medicare costs for which a privately insured or self-insured program can be held responsible.

The current implementation of MMSEA will likely enable even more rigorous enforcement, which will further enhance the need for accurate claim processing and resolution. This is partially because non-compliance -- in the form of inaccurate or inflated payments -- will result in hefty fines or penalties.

To address Medicare compliance as a core claim management responsibility, Sedgwick Claims Management Services, Inc. has developed an in-house, integrated option for its clients. Available to workers' compensation and liability claim management clients, Sedgwick's CMS Medicare solution includes Medicare set-aside determination, Medicare conditional payment ("lien") negotiation and resolution, and related consulting services.

"Medicare compliance is approached as an integral component of the client's claim management program rather than as an unrelated administrative afterthought, aligning Medicare services with overall claims program objectives," the company stated in a recent press release.

According to Sedgwick, its range of in-house services to optimize MMSEA compliance provides various advantages compared to traditional outsourcing models. For one, CMS Medicare specialists are said to be proactively engaged in the claim resolution cycle as early as possible. This can foster more cost-effective settlement arrangements, as well as timely and accurate reserving practices, the company said.

For more information about Sedgwick's claim management services, visit www.sedgwickcms.com.