28 Jan MEDICAID’S THIRD PARTY LIABILITY REQUIREMENTS
The Social Security Act, signed into law by President Franklin Roosevelt in 1934, specifies in statute § 1902( a)( 25) of the law "...
Third Party Liability Tag
27 May IMPROPER PAYMENTS – MEDICAID’S BILLION DOLLAR PROBLEM
Improper payments cost Medicaid $86.49 billion in 2020 alone. A common misconception is that improper payments come from fraud and abuse when in reality the majority come from prosaic, ordinary problems such as eligibility errors and antiquated data systems. Fraud in Medicaid may well still...
29 Oct A TIMELINE OF LEGISLATIVE EFFORTS TO ADDRESS MEDICAID THIRD PARTY LIABILITY
Since Medicaid’s inception in 1965, the program has expanded to become the largest provider of healthcare coverage in the country. As the member population size has grown, Medicaid third party liability (TPL) efforts and fiscal responsibility have been reoccurring issues. To protect Medicaid’s solvency, there...
20 Sep Medicaid Third Party Liability Report From GAO
Identifying third party liability continues to be a challenge under the coordination of benefits for Medicaid plans. By law, plans are payers of last resort so whenever beneficiaries have other active coverage (OHI), those third parties should pay first. Currently, Medicaid plans are required to...
23 Jul MEDICAID COSTS PUT EMPHASIS ON RECOVERY EFFORTS
In 1965, Title XIX of the Social Security Act established the Medicaid program to provide health care coverage to low-income individuals. Over time it has developed into one of the nation's largest payers for health care, covering one out of five Americans. In FY 2017,...
10 Apr REDUCING MEDICAID’S PRESCRIPTION DRUG COSTS
Since state Medicaid programs are responsible for the healthcare of several populations, skyrocketing prescription drug costs have become a major budgetary concern. Currently, health care spending is dominating many of their budgets and on a per capita basis, inflation-adjusted retail prescription drug spending has increased...
15 Aug Tackle Medicaid’s Improper Claims Payments With Data, Not ‘Pay and Chase’
The federal government must quickly move away from the "Pay and Chase" model where Medicaid routinely makes improper claims payments (those that were the liability of primary insurance plans), then retrospectively identifies the claims with third party liability. To make this change, the government must...
13 Jun How Rx Claims Trigger OHI Discovery & Cost Avoidance
When ProTPL discovers other health insurance, you can reverse the latest claim and ensure that future claims, whether pharmacy or medical, aren’t paid in error. Discovering other health insurance fast, triggered by Pharmacy claims, allows you to intercept the medical claims, such as office or...
29 Jul GAO Finds Medicaid Needs to Boost Third Party Liability Initiatives
Why GAO Did This Study During fiscal year 2013, Medicaid - collectively funded by states and the federal government - delivered health care insurance coverage to over 70 million people at an overall cost of about $460 billion. Our lawmakers generally established Medicaid as the health...
29 Jun State Medicaid Third Party Liability Cost Avoidance Q & A
Recently, I got into a discussion with a state Medicaid TPL director about RFPs for third party liability cost avoidance work. I feel that our cost avoidance solution would greatly benefit state-run plans, but RFPs are nearly always written for a single vendor to handle an assortment of...
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