Verisk’s Medicare Conditional Payment Resource Center – Improving Compliance With Automated Data-Driven Solutions

Medicare conditional payment claims continue to present several challenges for insurers. Understanding the different types of recovery claims is a critical first step in developing the necessary compliance protocols. For example, CMS uses an insurer's Section 111 reports to trigger recovery for Part A/B claims and utilizes two recovery contractors to pursue recovery against insurers and other parties. On the other hand, Medicare Advantage Plans (Medicare Part C) and Part D plans (RX Drugs) utilize their own processes. Insurers may be exposed to potential liability from: interest accrual, U.S. Department of Treasury claims, potential "double damages" lawsuits, possible Department of Justice actions, and other potential recourses.

To help make sense of it all, we are excited to present Verisk's Medicare conditional payments resource center which is a super "one-stop" resource containing key information regarding Medicare recovery claims and how Verisk's data-driven solutions automate the conditional payment recovery process to help simplify compliance and reduce costs.

This user-friendly resource provides helpful information as follows:

• Verisk's several different recovery services, including our popular CP Link^® program which automates lien resolution using Section 111 data, Treasury services, Medicare Advantage recovery services, and more!
• Policy resources, including several new articles breaking down the different Medicare conditional payments claims types.
• How we can help you develop claims handling protocols.
• A live link to schedule a call with our experienced conditional payment team.

As you prepare to review this resource, we proudly note that our experienced conditional team consistently delivers extraordinary conditional payments savings for our customers. For example, in 2024 alone, we saved our clients over $140 million in conditional payments savings and nearly $1 million in Treasury savings. In addition, our CP Link^® program achieved over $160 million in savings while our Medicare Advantage services delivered over $1.7 million in savings.

Of course, please feel free to contact the author if you have any questions or would like to learn how Verisk can help you address Medicare recovery claims!