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2024 Medicare Set-Aside Trends

For Insurance Adjusters: Why This Matters to You Insurance Adjusters, these Medicare Set-Aside trends directly impact your work in claims settlement and risk management. Understanding these developments is crucial for accurately estimating future medical expenses and ensuring compliance with CMS guidelines. Your key takeaways should be the increased scrutiny on prescription drug allocations, the need […]

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Avoiding Penalties, Compliance Basics, Medicare Set-Asides (MSAs)
Medicare Set-Aside

The Medicare Set-Aside (MSA)

Hello, fellow adjusters! Sheryl Thompson here, your friendly neighborhood Medicare Set-Aside Nerd. Today, we’re diving deep into the world of Medicare Set-Asides (MSAs). Grab your coffee, settle in, and let’s unravel this complex but crucial aspect of our work. Our Comprehensive Guide to Medicare Set-Asides for Insurance Adjusters What is a Medicare Set-Aside (MSA)? Simply

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Compliance Basics, Medicare Set-Asides (MSAs)
2024 WCMSA Update

2024 WCMSA Update

Hello again, fellow adjusters! Sheryl Thompson here, your Medicare Compliance specialist. It’s been several months since the 2024 WCMSA Update to the Self-Administration Tool Kit, and I’m still fielding questions about what it all means. So, I thought it was high time to revisit this topic, clarify a few things, and share some best practices

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Best Practices, Federal CMS Changes
Risk Manager talking Section 111 Reporting

Section 111 for Risk Managers

Section 111 for risk managers is crucial for ensuring your organization’s overall compliance with Medicare regulations. This guide to Section 111 Reporting for risk managers will help your organization navigate the complexities of Medicare reporting and collaborate effectively with your claims adjustment team. Section 111 for Risk Managers: A Comprehensive Guide by Sheryl Thompson Senior

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Avoiding Penalties, Compliance Basics, Medicare Reporting

Section 111 Reporting

As an insurance adjuster with over 15 years of experience in Medicare compliance, I’ve seen firsthand how Section 111 Reporting has transformed our industry. When I first encountered this topic, it seemed like an impenetrable wall of regulations and technical jargon. But over time, I’ve come to appreciate its importance and even find fascination in

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Medicare Reporting
TPA - Third Party Administrator

Self-Insured Clients Using TPAs

As an adjuster, handling claims for self-insured clients using TPAs presents unique challenges and opportunities. This configuration differs significantly from traditional insurance arrangements, and understanding these differences is crucial for effective claims management. Adjusting Claims for Self-Insured Clients Using TPAs: Essential Guidelines by Sheryl Thompson Senior Claims and Compliance Specialist Here’s what you need to

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Best Practices, TPAs
WCMSA Guide Update

WCMSA Reference Guide v4.1

Attention claims managers, insurance adjusters, and risk managers: The Centers for Medicare and Medicaid Services (CMS) has released the WCMSA Reference Guide v4.1, effective August 1, 2024. This latest version of the WCMSA Reference Guide brings significant changes that directly impact our day-to-day operations and long-term claim strategies. Let’s break down what you need to

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Federal CMS Changes, Legislative Updates, Tools & Resources

Medicare Beneficiaries

As insurance adjusters, one of our critical responsibilities is accurately identifying Medicare beneficiaries in our claims. This knowledge is crucial for ensuring compliance with Medicare Secondary Payer (MSP) regulations and avoiding potential penalties. In this article, we’ll explore the definition of a Medicare beneficiary and discuss best practices for determining beneficiary status. Understanding Medicare Beneficiaries:

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Compliance Basics
Picture of Glossaries

Medicare Compliance Glossary

This comprehensive Medicare Compliance Glossary is an essential resource for insurance adjusters and risk managers navigating the complex world of Medicare compliance. Tailored specifically to the needs of insurance professionals, it breaks down crucial terms, processes, and concepts into clear, practical explanations. From understanding various types of Medicare Set-Asides to grasping the intricacies of Section

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Compliance Basics, Tools & Resources
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