Medicare Demand Letters, Voluntary Data Sharing Arrangements - Health Decisions Inc. Helps Self- Insured Employers and Health Insurance Companies Peacefully co-exist with Medicare

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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.

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 http://www.healthdecisions.com, send an inquiry to hdi@healthdecisions or call 800.589.2500.

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