CUTTING EDGE INDUSTRY THOUGHT LEADERSHIP INSIGHTS

Synergy’s blog brings you the industry’s foremost thought leadership InSights on matters of healthcare lien resolution and Medicare Secondary Payer Compliance. Visit often to discover helpful InSights on important lien resolution compliance issues.

Liability Medicare Set-Asides, Administration, and the Consequences of Faulty ORM Reporting

When a personal injury settlement covers future medical expenses for a Medicare beneficiary, counsel must decide how to allocate those funds and who should administer them. This post explains what is and isn’t known about liability Medicare set-asides, how professional and self-administration compare, and how Section 111 ORM reporting works. It also shows how to fix a situation where Medicare keeps denying claims because a no-fault insurer never reported the end of its ongoing responsibility for medicals.

Read Post

How to Reduce a Hospital Lien: Why Reasonableness of Charges Wins the Fight

Most hospital lien negotiations start from the wrong number. This post explains why billed charges function more like list prices than a measure of reasonable value, how to determine whether a provider holds an enforceable lien versus an unpaid debt, how to test whether that lien was properly perfected, and how to build a defensible reasonable value range using Medicare rates, commercial negotiated rates, and cost report data. It also covers auditing the itemized bill, catching balance billing violations, and layering statutory and equitable arguments on top of the reasonableness case.

Read Post