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Welcome to our blog page! Here, you’ll find a collection of blogs written by our Synergy experts on a wide range of topics related to lien resolution, government benefit preservation, Workers Compensation, and more. While these blogs may not fit neatly into a specific category, they contain valuable information and InSights that we believe will be of interest to our clients and readers. Our team is committed to staying up-to-date on the latest developments and trends in the industry, and we’re excited to share our knowledge and expertise with you. Check back often for new blog posts and updates on a variety of topics!
In our previous blog, we tackled the Medicare conditional payment resolution process. However, if your client, during treatment for their injuries, switched to a Medicare Advantage Plan (MAO-Part C), the resolution process might not be over. Here’s why: While you may have resolved conditional payments with Medicare Parts A and B (traditional Medicare), MAO plans operate independently and may have covered some or all of your client’s medical expenses.
The issue arises because MAO plans are distinct from traditional Medicare, and beneficiaries can enroll in them during specific periods. Consequently, even if you resolved Medicare conditional payments, an MAO might have stepped in later, without your knowledge. CMS will not notify you about these MAO payments, and beneficiaries often lack clarity on their coverage types so it can easily be missed.
To verify MAO plan coverage, clients can check their status on MyMedicare.gov. Additionally, the 2020 PAID Act requires CMS to report MAO enrollments for the past three years, though access to this data is limited to Non-Group Health Plan Responsible Reporting Entities (RREs). You might need to request this information from the defense or painstakingly review medical bills to uncover potential MAO liens.
Attorneys must be vigilant, conducting thorough due diligence to uncover possible MAO liens. Failure to address these could result in double damages, as MAOs do enforce their reimbursement rights aggressively. The Medicare Secondary Payer Act grants MAOs the right to sue for double the lien amount if not repaid, a risk highlighted by cases like Humana v. Western Heritage Ins. Co. Here, Humana successfully claimed double damages after Western Heritage failed to reimburse a $191,000 lien.
To prevent such pitfalls, start your investigation early upon client intake, continue throughout representation, and finalize it before disbursing settlement funds. Identify any MAO liens and seek reduction or compromise as appropriate. Understanding and managing MAO liens is crucial to safeguarding your firm against significant financial exposure for this hidden lien.
Working with specialized lien resolution companies can provide essential expertise and prevent costly mistakes when it comes to Medicare Advantage plan liens. If you want to find out more, contact us today to Partner with Synergy for lien resolution.
Written by: Jason D. Lazarus, J.D., LL.M., MSCC | CEO
In personal injury law, attorneys focus on proving causation, liability, and damages. Given the complexities that arise during settlement, outsourcing certain tasks has become a common practice to enhance efficiency and client outcomes. Just as attorneys engage experts in probate, guardianship, tax matters or even medical record retrieval, lien resolution can similarly benefit from specialized assistance. This approach not only addresses the complications of lien resolution but also when done correctly complies with ethical requirements and improves client outcomes.
Why Outsource Lien Resolution?
Personal injury attorneys often face multifaceted lien issues that are governed by intricate laws and regulations, such as ERISA, the Medicare Secondary Payer Act, and various state-specific laws. For instance, a client may have multiple Medicare components—Traditional Medicare (Parts A/B) and Medicare Advantage (Part C)—each with distinct obligations and requirements. Navigating these can be overwhelming, especially when dealing with several different lien types in one case.
Ethical Considerations
Outsourcing lien resolution is both practical and ethical, provided it is managed correctly. ABA Formal Ethics Opinion 08-451 outlines that while lawyers can outsource legal and non-legal support services, they must retain ultimate responsibility for the work and maintain direct supervisory authority. This means that while lien resolution experts can handle the details, the attorney oversees their work and ensures compliance with all professional obligations.
State-Specific Guidelines
Different states have addressed the outsourcing of lien resolution. For example, New York permits lawyers to hire external lien resolution firms as long as the costs are reasonable, disclosed to the client, and result in a net benefit. Similarly, Ohio and Utah have established that outsourcing is permissible under certain conditions, including obtaining client consent and ensuring the fees are reasonable and transparent.
Key Takeaways
- Efficiency and Expertise: Outsourcing lien resolution can streamline the process, reduce operational costs, and leverage the expertise of specialists to enhance client outcomes.
- Ethical Compliance: Ensure that the outsourcing process adheres to ABA Model Rules and state-specific guidelines, including maintaining client confidentiality, securing informed consent, and ensuring costs are reasonable.
- Client Benefit: The primary goal of outsourcing should be to protect and maximize the client’s recovery. This approach helps ensure that lien resolution is handled expertly, safeguarding against potential legal and financial risks.
In conclusion, outsourcing lien resolution is a strategic decision that, when done ethically, helps a law firm run more efficiently and benefits clients by securing better outcomes. If you want to do a deep dive into ethical outsourcing of lien resolution, click HERE to download our white paper called “How to Outsource Lien Resolution Ethically”. If you are ready to outsource today and partner with Synergy, contact us TODAY.
Written by: Jason D. Lazarus, J.D., LL.M., MSCC | CEO
As a trial lawyer, you might wonder why you should consider outsourcing lien resolution when it seems manageable to handle in-house. Additionally, you may question whether it’s ethically permissible to engage a lien resolution company like Synergy. The answers to these questions highlight both practical and ethical considerations essential for personal injury law firms to operate at peak efficiency.
Why Outsource Lien Resolution?
Efficiency and Expertise: Handling liens is a complex, time-consuming task that often diverts focus from core legal work for personal injury law firms. When law firms resolve liens in-house, they must investigate, identify, audit, verify and resolve various liens, including subrogation claims and debts against settlements. This involves assessing the legal validity of claims and engaging in protracted negotiations. Given these responsibilities, it is easy to see why outsourcing can enhance efficiency. Specialized lien resolution firms bring deep expertise and dedicated resources, offering a streamlined process that can significantly reduce the burden on a personal injury firm.
Navigating Complexities: The landscape of lien resolution involves dealing with various types of liens, including Medicare, Medicaid, ERISA, and more. Each has its own set of rules, regulations and resolution processes. Government benefit plans and recovery vendors are often large, well-funded entities with the sole focus of recovering money from personal injury settlements. These organizations have extensive resources and sophisticated strategies to assert their claims. Partnering with a lien resolution expert allows you to leverage their specialized knowledge and negotiation skills, leveling the playing field when confronting recovery contractors.
Cost-Effectiveness: Outsourcing lien resolution can also be financially advantageous. The costs associated with managing liens internally—such as time, resources, and potential delays—can add up quickly. By outsourcing, a personal injury law firm can reduce operating expenses and avoid the inefficiencies associated with handling these tasks in-house. This approach allows you to focus on moving cases toward settlement or trial, ultimately improving your firm’s bottom line.
Ethical Considerations When Outsourcing
Compliance and Integrity: It is important to ensure that outsourcing lien resolution complies with ethical and legal obligations. Law firms must adhere to specific rules governing the management of client funds and lien resolution. This includes maintaining transparency and ensuring that the outsourced firm operates within the legal and ethical frameworks set by the applicable Bar regulatory bodies. A future blog post will address how to comply with ethical rules when outsourcing lien resolution, ensuring that client interests are protected and professional integrity is maintained.
Conclusion
Outsourcing lien resolution is more than a logistical decision; it is a strategic move that can greatly benefit personal injury law firms. It provides access to specialized expertise, enhances efficiency, and reduces operational costs. While navigating lien laws can be challenging, partnering with a dedicated lien resolution team ensures that you can achieve optimal results for your clients and maintain a competitive edge in your practice.
If you want to learn more about outsourcing, click HERE to download our “Strategic Benefits of Outsourcing Lien Resolution for Personal Injury Law Firms” white paper. If you would like to get started with outsourcing lien resolution and partner with Synergy, contact us today!
Written by: Jason D. Lazarus, J.D., LL.M., MSCC | CEO
In the complicated world of personal injury practice, lien resolution is a pivotal yet often daunting aspect of the resolution process for cases. For trial lawyers, the task of the resolution of various liens can be both challenging and crucial to maximizing the client’s net recovery. The evolving complexity of healthcare reimbursement systems and the rigorous regulatory requirements of government plans necessitate a meticulous approach to lien resolution.
Understanding Lien Resolution
Lien resolution requires a detailed process for addressing and negotiating claims made by healthcare providers, government agencies, and other entities against a portion of a settlement in a personal injury case. These claims, or liens, must be resolved to ensure that settlement funds are distributed to the injured party free of any future claims by healthcare providers or insurance plans. Failure to resolve liens correctly can lead to significant financial and legal consequences for everyone involved.
The Importance of Lien Resolution
- Client Recovery: The accurate and efficient resolution of liens is essential for maximizing the amount of settlement funds available to the client. A less-than-optimal lien resolution process can drastically reduce the client’s net recovery, creating more financial strain post-settlement and less satisfaction with the outcome.
- Compliance: Adhering to legal and ethical requirements is crucial. Different types of liens—such as those from Medicare, Medicaid, ERISA, FEHBA, Military, hospital, and private health insurance—come with specific resolution processes and legal issues. Understanding and complying with these processes/laws is vital to avoid complications.
- Financial Responsibility: Appropriate resolution helps prevent financial liabilities for all involved parties. Incorrect handling can result in claims against settlement funds even after they’ve been disbursed, potentially leading to additional financial burdens.
- Professional Reputation: Efficiently resolving liens not only satisfies clients but also enhances an attorney’s reputation. Positive outcomes and satisfied clients often translate into more referrals and better professional reviews online.
Lien resolution is more than just a procedural necessity; it is a critical element in ensuring that clients receive the maximum net recovery from their settlements. For trial lawyers, mastering this aspect of resolution is essential for achieving optimal outcomes and maintaining a high standard of professional excellence. In many situations, it may be best to outsource this function to reduce liability, eliminate internal costs of resolution, and get the best net recovery for the client.
If you want to learn much, much more about lien resolution and outsourcing, click here to download our Outsourcing & Lien Resolution Guide for Trial Lawyers. To learn more about partnering with Synergy for lien resolution click HERE.
Written by: Jason D. Lazarus, J.D., LL.M., CSSC, MSCC | CEO
Introduction
In the world of personal injury law practice, balancing profitability with exceptional operational efficiency poses a significant challenge. You want to deliver world-class customer experience while getting the balance right with running your firm efficiently as well as profitably. To navigate this challenge, law firms can utilize the Entrepreneurial Operating System (EOS) Traction model in combination with outsourcing. This dynamic combined approach helps streamline operations, boost efficiency and ultimately drive profitability. This blog discusses, at a high level, how personal injury law firms can incorporate these strategies to achieve outcomes.
Understanding the Fundamentals of the EOS Traction Model
The EOS Traction model, crafted by Gino Wickman offers a framework for managing and optimizing businesses. While some may feel a law practice is different, the Traction model works with any business enterprise. It revolves around six core elements:
- Vision: Establishing a shared vision for the firm to align all team members toward objectives that need to be achieved. Think of something like the mission to help injured parties recover just compensation!
- People: Ensuring that individuals are in roles to maximize productivity and job satisfaction. Making sure the right people are in the right seats within your firm to deliver on your vision.
- Data: Utilizing metrics and data to inform decision making processes and monitor performance. Looking at critical KPIs within your business (law practice) to ensure you are achieving what you have set out to do.
- Issues: Promptly identifying and resolving issues to uphold operations. Every business, and your law firm, is no different, has operational issues that need to be solved so this process is an incredibly important one.
- Process: Documenting and refining fundamental processes to guarantee consistency and efficiency. The key to consistency and longevity, as well as scale, is documented processes. Especially important for firms in growth mode or looking to grow.
- Traction: Enforcing disciplined execution and accountability to reach the firm’s goals.
By embracing the EOS Traction model, personal injury law firms can establish a foundation to drive continuous growth and profitability. While it may not be as straightforward as it seems at first glance there’s no need to worry because numerous EOS experts, with knowledge of law firm operations, can play a pivotal role in implementing EOS within your practice.
Incorporating Strategic Outsourcing
While the EOS Traction model offers a structure for efficiency, strategic outsourcing complements it by taking specific tasks off your team’s place and giving to an external team that are specialists. Outsourcing enables law firms to concentrate on their core strengths while tapping into know-how for functions that can be handled more effectively by experts. Key potential areas for outsourcing tasks many personal injury law firms do inhouse today include:
Lien Resolution
- Expertise and Efficiency: Outsourcing lien resolution to specialized firms ensures compliance with complex regulations and maximizes lien reductions, allowing the firm to focus on client advocacy. It removes the burden of administrative work from a law firm’s staff, creating more efficiency and profitability for the law firm.
- Risk Mitigation: Specialized lien resolution groups stay updated on legal developments, reducing the risk of errors and compliance issues when outsourced to an experienced lien resolution company.
Medical Records Review
- Detailed Analysis: Outsourcing the review of medical records to experts ensures thorough and accurate documentation, supporting stronger outcomes.
- Time Savings: External reviewers can handle large volumes of records quickly, freeing up internal resources for other critical tasks.
Marketing and Lead Generation
- Targeted Campaigns: Professional marketing firms can design and execute targeted campaigns to attract potential clients, increasing the firm’s caseload and revenue.
- Analytics and Optimization: Marketing experts provide insights and analytics to optimize campaigns, ensuring the best return on investment.
Maximizing Profitability through EOS Traction and Outsourcing Integration
When integrated, the EOS Traction model and strategic outsourcing create a powerful synergy that drives efficiency and profitability in personal injury law firms. Here’s how:
- Core Competency Focus
By outsourcing specialized tasks, law firms can focus on their core competencies, such as client representation and legal strategy, ensuring higher quality service and better case outcomes.
- Scalability and Adaptability
Outsourcing provides scalability, allowing firms to handle increasing caseloads without the need for significant internal resource additions. This flexibility supports growth and profitability.
- Data Driven Decision Making
The EOS Traction model emphasizes data-driven decision-making. By developing key metrics for operations, firms gain access to advanced analytics and insights, informing strategic decisions and optimizing performance.
- Optimizing Operations
By documenting and fine-tuning procedures using the EOS framework, operations can be streamlined. This helps to minimize inefficiencies, reduce expenses and boost productivity.
- Enhanced Client Satisfaction
Efficient operations lead to faster resolution of cases and improved client outcomes. This in turn results in higher client satisfaction and positive testimonials/Google reviews, which are crucial for the firm’s continued growth.
Conclusion
Combining the EOS Traction model with strategic outsourcing offers personal injury law firms a comprehensive approach to achieving operational excellence and profitability. By focusing on core competencies, leveraging external expertise, and implementing disciplined execution and accountability, firms can navigate the complexities of personal injury law firm practice with greater success. This approach not only enhances profitability but also ensures sustained growth and client satisfaction, positioning the firm for long-term success in a competitive market.
If you want to learn more about outsourcing lien resolution to Synergy, go to www.partnerwithsynergy.com
To learn more about the Traction/EOS model go to www.eosworldwide.com
Personal injury attorneys will often rely on Medical Cost Projections (MCP) when seeking to establish future medical damages in their cases. The MCP provides a roadmap of the future injury-related care and an estimate of the cost of such services. This article provides a comprehensive overview of healthcare billing and the methodology used by allocators in pricing future medical services.
Overview of Healthcare Billing
The U.S. healthcare system is often criticized for its complex and opaque billing practices. One of the most significant flaws in the U.S. healthcare billing system is the lack of transparency in pricing. Unlike other industries where consumers can easily compare prices, healthcare providers often do not disclose the costs of services upfront. The cost of identical medical services can vary widely between providers and even within the same facility, depending on factors such as location, the provider’s negotiation with insurers, and the patient’s insurance plan. Billing is often fragmented and comes from multiple providers for a single episode of care, including hospitals, physicians, labs, and other ancillary services.
The use of CPT codes for billing introduces complexity and potential for error. CPT codes are standardized numeric codes maintained by the American Medical Association (AMA) used to describe medical, surgical, and diagnostic services. These codes are essential for:
- Communicating uniform information about medical services and procedures between healthcare providers, insurers, and patients.
- Facilitating accurate billing and efficient claims processing.
- Ensuring compliance with healthcare regulations.
Upcoding occurs when healthcare providers submit claims using CPT codes that represent more extensive or higher-cost services than those provided. This practice can result in increased reimbursement from insurers, leading to higher costs for payers and patients. Examples of upcoding include the following: billing for a comprehensive office visit when only a brief consultation was conducted, coding for a more complex surgical procedure than was performed and submitting codes for services not medically necessary or not provided.
Pricing in the medical field involves various factors with the fundamental components being the cost of services and the need to generate a profit. Direct costs consist of medical supplies, equipment, and labor, while indirect costs include facility maintenance, administrative expenses, and insurance. Medical providers also consider the prevailing market rates for similar services in their geographic area. In regions with higher competition, prices may be lower to attract patients. Conversely, in areas with fewer medical facilities, providers may have more pricing power.
The payer mix, or the proportion of revenue coming from private insurance, government programs (such as Medicare and Medicaid), and self-paying patients, also significantly influences pricing decisions. Medicare and Medicaid typically reimburse at lower rates than private insurers. To compensate for these lower reimbursements, providers may increase prices for services billed to private insurance or self-paying patients. The agreed-upon rates between insurance companies and providers are often influenced by the provider’s reputation, specialty, and bargaining power. Larger healthcare systems or providers with unique specialties may command higher rates.
Patient demographics and socioeconomic factors also play a role in pricing decisions. Providers may adjust prices based on the demographic makeup of their patient population. In affluent areas, higher charges might be feasible, while in lower-income communities, providers might offer discounts or sliding scale fees to accommodate patients’ financial capabilities.
Medical Pricing Databases
Allocators that prepare MCPs use medical pricing databases such as, but not limited to, Medata, FAIR Health and Healthcare Bluebook in estimating the cost of the future injury-related medical services. These databases collect, analyze, and disseminate data on healthcare costs across various providers, regions, and types of services. They aggregate pricing information from insurance claims, Medicare data, and other sources to provide comprehensive cost estimates for a wide range of medical services.
Medata is a leading medical pricing database known for its extensive and detailed cost information. It provides real-time data on medical procedures, treatments, and services from common procedures to specialized care, and offers pricing information segmented by geographic region, type of provider, and payer type. FAIR Health is another prominent medical pricing database which compiles data from millions of healthcare claims nationwide, offering a comprehensive overview of costs. Healthcare Bluebook provides transparent pricing data for healthcare services, helping users understand fair market prices. This tool is particularly useful for comparing costs across different providers and ensuring that estimates reflect realistic market conditions.
MCPs may be customized to reflect a specific percentage of the usual and customary rates over an individual’s life expectancy. The medical pricing databases also provide Medicare fee schedule pricing as well as workers’ compensation state specific medical fee schedule rates. There are other databases for the pricing of drugs.
Conclusion
Medical Cost Projections play an important role in quantifying future medical treatment costs. By leveraging the MCP, lawyers can enhance their case preparation and negotiation strategies, ultimately securing better results for their clients. Contact Synergy to learn more about how our MCP report can simplify the negotiation of future medical care for your case.
Written by: Rasa Fumagalli, JD, MSCC, CMSP-F
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