Medicare Demand Letters, Voluntary Data Sharing Arrangements - Health Decisions Inc. Helps Self- Insured Employers and Health Insurance Companies Peacefully co-exist with Medicare
The Medicare Secondary Payor (MSP) Program has resulted in an increasing number of employers receiving Medicare Demand Letters. Health Decisions, Inc., of Plymouth, MI, not only helps protect a self-insured employer or health insurance company from receiving Medicare Demand Letters but also can help collect money from Medicare.
Plymouth, MI (PRWEB) October 1, 2004 -- One of the worst pieces of mail an
employer can receive from the federal government is a Medicare Demand Letter
that states, in short, Uncle Sam Wants Your Money!
The Medicare Secondary
Payor (MSP) Program has resulted in an increasing number of employers receiving
Medicare Demand Letters.
With other finance revenues drying up, the
federal government will do what it can to slow the drain on Medicare, Medicaid
and Social Security coffers. So Medicare is becoming very aggressive in
collecting money from other sources to reduce its own payables.
Health
Decisions, Inc., of Plymouth, MI, not only helps protect a self-insured employer
or health insurance company from receiving Medicare Demand Letters but also can
help collect money from Medicare.
A worker older than 65 may be covered
by the active health plan at his place of employment and still be drawing
Medicare payments. If Medicare discovers that it has paid a claim to an employee
covered by a private plan, that employer will receive a Demand Letter in the
mail insisting that Medicare be reimbursed, with penalty, for the claim that
should have been paid for by the company’s health plan.
The obligation
for payment can stretch back for many years and may involve a substantial
penalty. So what should an employer do to avoid getting such unwanted mail?
Beyond protecting itself from receiving Demand Letters, employers also
should be interested in balancing the scales by getting money back from Medicare
that is owed them. Health Decisions, Inc. provides a level playing field
allowing the employer to take advantage of Voluntary Data Sharing Arrangements
(VDSA).
VDSA involves a company conducting quarterly data matches with
Medicare in compliance with federal law. Doing so eliminates future Medicare
Demand Letters and, more importantly, permits identification and recovery of
funds owed by Medicare to the employer.
Enrollment in VDSA allows
Medicare to update its internal records and avoid making mistaken primary
payments, thus eliminating a future Demand Letter being sent out. In exchange,
Medicare provides the employer or insurer with valuable Medicare eligibility
information on employees who are no longer working. Savings for employers and
insurers can be significant.
Health Decisions’ technology takes employer
data and coordinates with Medicare to make sure there are no surprise Demand
Letters and to identify any money owed to the employer's plans. Taking advantage
of cutting edge technology few firms, other than Health Decisions, offer does
this.
Health Decisions has worked closely with consultants, brokers and
health plans to assist them in helping their clients deal with Medicare
secondary payors. “We offer to small and medium businesses the same kind of
technical specialization the jumbo companies have,” says Si Nahra, Ph.D.,
founder and president of Health Decisions, Inc., Plymouth, MI. “We help
companies balance the scales by making demands on Medicare.”
What is
important for anyone to remember is that Medicare may not always be the primary
source of payment for health services for Medicare beneficiaries. In 1980
Congress enacted legislation providing that Medicare may not make payments for
services that are covered by certain other insurance programs. That law has made
it very difficult for employers and payors to track whether Medicare is primary
or secondary.
Although they might feel singled out, employers need to
take Demand Letters seriously and provide timely responses in order to avoid
civil monetary penalties and/or a lawsuit. Because of the complexity of Medicare
Primacy, many companies choose to go beyond in-house staff and hire consultants
or professional service firms to avoid receiving Demand Letters and to collect
money due them from Medicare.
About Health Decisions:
Health
Decisions, Inc., a privately owned, Michigan Corporation, specializes in benefit
data management services to clients throughout the country.
Since 1985,
Health Decisions, Inc. has successfully served hundreds of clients -- HMOs,
insurers, TPAs and self-funded groups of all sizes. The firm successfully
processes annually more than a billion dollars of paid claims data and processes
special surveys for more than 225,000 covered members.
Health Decisions
has taken its core competencies of technical expertise, data sophistication, and
a pragmatic service orientation and developed a series of products with proven
value and considerable potential for growth.
Health Decisions, Inc.
distinguishes itself with its service philosophy: Respect for existing
procedures; emphasis on customization; and, focus on solutions
For
further information about Health Decisions, Inc. Medicare Recovery services,
including VDSA, and its pioneering Post Payment Administration program go to www.healthdecisions.com,
send an inquiry to hdi@healthdecisions or call 800.589.2500.
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Source : http://www.prweb.com/releases/2004/10/prweb163058.htm