Synergy Blog

CMS Continues Push to Reduce Improper Payments Under the Medicare Program

December 10, 2020 Rasa Fumagalli, JD, MSCC, CMSP-F The Centers for Medicare & Medicaid Services (CMS) recently issued a press release announcing a steady decline in improper payments under the Medicare Fee-For-Service program over the past few years. The improper payment rate decreased to 6.27% in the fiscal year 2020, down from 7.25% in the…

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Liability Medicare Set-Asides: Where are we Today?

November 12, 2020 By: Rasa Fumagalli, JD, MSCC, CMSP-F The Centers for Medicare and Medicaid Services (CMS) has been slow in providing detailed guidance in the area of liability settlements that include compensation for future medicals. To date, the guidance consists of the May 2011 CMS Stalcup memo and the September 2011 CMS memo regarding…

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6 Real-World Considerations for Advanced Settlement Planning

November 10, 2020 Mrs. Smith was moved to the ICU and no neurologic monitoring was performed that evening after being moved from the surgical suite. The next morning, Mrs. Smith was found to be quadriparetic. A suit was brought against multiple defendants with a significant seven-figure recovery secured. Mrs. Smith and her family had Medicaid…

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What is a Medicare Set-Aside?

October 27, 2020 For many years, personal injury cases have been resolved without consideration of Medicare’s secondary payer status even though since 1980 all forms of liability insurance have been primary to Medicare. At settlement, by judgment or through an award, an injury victim would receive damages for future medical expenses that were Medicare-covered. However,…

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Discussing the Workers’ Compensation Medicare Set-Aside with your Client

October 21, 2020 By: Rasa Fumagalli, JD, MSCC, CMSP-F By now, most workers’ compensation practitioners are familiar with the Centers for Medicare & Medicaid Services (CMS) voluntary review process involving Workers’ Compensation Medicare Set-Aside Arrangements (WCMSA). CMS is currently willing to review settlements that exceed $25,000.00 in cases involving a Medicare beneficiary. Settlements that involve…

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How the Advent of the Mandatory Insurer Requirement Causes Problems for Lawyers

October 13, 2020 As of April 1, 2011, a Responsible Reporting Entities/insurers (RRE), (liability insurer, self-insurer, no-fault insurer, and workers’ compensation carriers) must determine whether a claimant is a Medicare beneficiary (“entitled”) and if so, provide certain information to the secretary of Health and Human Services (hereinafter “secretary”) when the claim is resolved. This is…

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What are Your ERISA Plan’s Recovery Rights?

October 7, 2020 Most, if not all, ERISA health insurance plans state that injuries caused by a liable third party are not a covered expense and require reimbursement when a plan pays for injury-related medical expenses (often referred to as subrogation clauses). ERISA provides that health plans which qualify under its provisions can bring a…

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The Unregulated New Frontier of Medicare Set-Asides

September 29, 2020 Excerpt from The Art of Settlement Consider this scenario: you represent a current Medicare beneficiary in a third-party liability case. As part of the workup of the case, you determine the client will need future medical care related to the injuries suffered, and you settle the case. Since the client is a…

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My new book, The Art of Settlement, is officially live!

September 22, 2020   I’m excited to announce that my new book, The Art of Settlement, officially launches today. What is The Art of Settlement? The regulatory landscape of the personal injury lawyer has become exceedingly complicated.  Assisting clients with catastrophic disabilities now exposes you personally to government recovery actions, damages, and malpractice risks. It’s vital that your personal…

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Compliance Strategies for Closing Cases in 2020 and Beyond

Suffering even a moderate personal physical injury can create difficult challenges both financially and emotionally for even the strongest among us. However, what happens when someone suffers a serious or catastrophic personal physical injury? Do they get the proper counsel regarding the form of the settlement to protect their current assets, preserve public benefits, and…

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Greater Understanding for More Effective ERISA Lien Negotiation

August 13, 2020 By: Teresa Kenyon Medical liens or reimbursement demands are generally an unwelcomed part of the whole recovery process for personal injury attorneys.  It’s the case after the case. The target is always moving and there is a lot of information to process and laws to apply. This is generally not the chore…

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TESTIMONIALS

“Synergy is our guiding light for deferring our contingent legal fees and planning for retirement. The lawyers at Panter Panter & Sampedro, myself included, have been working with them for over ten years using different methods to defer comp and plan for retirement.”

Brett Panter
Panter, Panter & Sampedro

"I don't think I've directly said "thank you" for helping us with Bridgett’s case. We sent the reduced payment to Medicaid and called Bridgett's mom to tell her approximately how much money was going to be left for Bridgett and she broke down over the telephone. Given only $25k of insurance and a $850k medical bill from the hospital she didn't think Bridgett would ever see a penny."

Tom L. Copeland
Jeffrey Meldon & Associates, P.A.

Hospital "Liens" vs. "Debts": A Distinction With a BIG Difference ​​​​​​​Third Thursday Webinar Series

Join Director of Synergy Medical Bill Clinic, Michael Walrath, Esq. as he delves into the differences between “direct provider liens” and mere “medical debts.” In this webinar, he will describe how and why these important distinctions impact the lien resolution process and expected outcomes, while also dictating the various ethical and legal exposures faced by Plaintiffs’ Lawyers, post-settlement. A 15 minute Q&A will follow the presentation.

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