Settling claims involving Medicare beneficiaries adds compliance requirements under the Medicare Secondary Payer Act, including reimbursement of conditional payments and consideration of future medical exposure. When these obligations are addressed late, adjusters often face delays, disputes, and added financial risk.
Early identification of Medicare status and proactive communication with all parties helps set expectations and avoid disruptions. Adjusters must also decide between submitted and non-submit Medicare Set-Asides, balancing regulatory certainty against speed and flexibility.
Clear settlement language and accurate Section 111 reporting are essential to prevent post-settlement issues. Addressing MSP obligations early allows adjusters to reduce cycle times, improve outcomes, and manage risk more effectively.
