Obtaining Optimal Results

Posted by Matthew Garretson and Elizabeth Vish Schad

Question:
Do you have a checklist/ timeline that goes through the various steps to get thing done right and within 100 days? Is there something like query access available to the plaintiff's attorney? Does the outsourcing mean that this becomes an iterm of cost and not fees?

-Recent Seminar Attendee

Answer:
We do have internal protocol that we follow in order to obtain optimal results. Below are some highlights from our internal protocol that have been featured as a practice tip:

Within a couple weeks of contacting COBC on newly settled cases, you should receive a letter from the MSPRC. Keep in mind that the first task of the MSPRC on new submissions is to identify all payments and generate a conditional summary. In this regard, the best recommendation this author has is to utilize a rifle shot approach - When you respond to the MSRPC provide them all the documentation requested along with the exact detail they need to push your case through the bottleneck, including the exact window of time involved (date of injury to date of settlement) and the exact ICD 9 codes related to the injury and settlement.
Further information is available in our article, Medicare’s Reimbursement Claim, the Only Constant is Change.

Under MMSEA, there will be query availability, but it’s our understanding that this functionality will only be available to RRE’s for entitlement inquiries. Currently, something like query access is not available to the plaintiff’s attorney.

Outsourcing allows for improved fees based on volume and mix of cases and leveraging economies of scale. Whether healthcare lien resolution is considered a cost or a fee is dependent on the language in your fee agreement.