Medicare Advantage

If Medicare Conditional Payments were not enough, you now have Medicare Advantage Organizations (MAOs) to worry about. In the "old" days, you could treat an MAO like private insurance. Over the past five (5) years, those practices have changed for a number of reasons. MAOs have become increasingly more aggressive in asserting the same recovery rights as traditional Medicare Fee-for-Service (Parts A and B). Here are some tips to help address the potential recovery rights of an MAO:

Ask the Right Questions

In order to identify the potential involvement of a MAO, you need to understand what to look for in the fact pattern. First, ask the injured person if they are Medicare enrolled. If so, obtain copies of their Medicare cards. They may provide you with a traditional Medicare card, an insurance card from a MAO, or both.

Start with Traditional Medicare

Once you know that Medicare is involved, ask Medicare for a conditional payment letter. That process is found here. After receiving the conditional payment letter, review the itemization carefully. Are all items, services, and expenses accounted for? Is the itemization continuous with no unexpected interruptions in coverage? If the answer to either one of those questions is 'no', a MAO may be out there.

Understand Traditional Medicare Does Not Provide MAO Information

To most, Medicare is Medicare. Some will assume that the conditional payment listing from Medicare would cover all things Medicare (i.e., charges related to Parts A, B, C and/or D). IT DOES NOT.

The conditional payment listing from Medicare only covers Parts A and/or B. It will not detail charges paid by a MAO or a prescription drug plan. Those must be obtained from other sources. This means you have to figure out who is providing that insurance coverage to the injured person.

Negotiate with the MAO

Once you identify the MAO, the question becomes if/how to negotiate with it to minimize the repayment obligation. While some MAOs handle their own recovery, others will engage recovery agents to work on its behalf. The length of time it takes to resolve a MAO conditional payment obligation can vary.

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