Latest news with #MedicareSecondaryPayer
Medical News Today
12-05-2025
- Health
- Medical News Today
Coordinating benefits and recovery in Medicare
Coordination of benefits rules determines which insurer pays first when someone has multiple health plans, including Medicare. Medicare can challenge this process through recovery. Benefit coordination is integral to the Medicare Secondary Payer Program. This assists Medicare in identifying situations in which the insurer should not be the primary payer for claims. The Benefits Coordination & Recovery Center (BCRC) and the Commercial Repayment Center (CRC) handle various components of the coordination and recovery process. This article gives further insight into how Medicare coordinates and recovers benefits. How does the coordination of benefits work with Medicare? Medicare typically acts as the primary payer when a person has insurance with Medicare and another health insurance plan, such as a group health plan of under 20 employees or Continuation of Health Coverage (COBRA). However, in other situations, Medicare becomes the secondary payer. These circumstances include when: a person's employer has 20 or more employees the person has a disability and has coverage by a plan from an employer with 100 or more employees an individual is living with end stage renal disease (ESRD) Additionally, Medicare might pay second (secondary payer) if a person is involved in an accident and covered by no-fault or liability insurance or if workers' compensation covers them. How long is the coordination period for Medicare? The coordination of benefits period can last as long as 30 months. What is CMS's Benefits Coordination and Recovery Center? The Centers for Medicare & Medicaid Services (CMS) uses the BCRC to determine whether a person has health insurance coverage other than Medicare. Occasionally, after Medicare pays a claim, the BCRC may discover that a person's group health plan should have been the primary payer. In such instances, the CRC recovers the funds from the employer and the group health plan. Additionally, the CRC is responsible for recovering incorrect payments when a person is self-insured or if liability insurance, no-fault insurance (personal injury protection insurance), or a workers' compensation provider is involved. How do I fix Medicare's coordination of benefits? Understanding the coordination of benefits and recovery process can be challenging. It is important to understand that when a person has two health insurance policies, the primary insurer will cover expenses up to its coverage limit first. If any costs remain, the secondary payer will step in. However, the secondary payer, such as Medicare, might not cover every remaining expense. On the other hand, there may be instances where Medicare is the primary insurance, and an employer's plan is the secondary. In these cases, the insured person may need to enroll in Original Medicare's Part B plan instead of an equivalent Medicare Advantage (Part C) plan for their employer's insurance to help with their costs. Some other factors to consider include: If a person is dually enrolled in Medicaid and Medicare, Medicaid will always be the secondary payer. If an individual is in the military and enrolled in Medicare, TRICARE is the primary payer for Medicare services. If the other insurance is part of a multiple-employer plan, only one of these plans needs to meet the employee count requirement for the group health plan to be the primary payer. Who should a person call if they have a Medicare coordination of benefits issue? It is crucial to inform the CMS if changes occur in a person's insurance coverage outside of Medicare. In addition, if someone is uncertain which insurance provider should be the primary payer, they can review the insurance policy or coverage details of their other plan. They can also contact their employer, union benefits administrator, or the BCRC at 855-798-2627 (TTY 1-855-797-2627). If a person believes there an error has occurred in how Medicare and their other insurer have allocated coverage, they can file an appeal. They can find out more about the appeal process on The Medicare Secondary Payer program helps Medicare identify instances where it should not be the main payer for medical claims. The Benefits Coordination & Recovery Center (BCRC) and the Commercial Repayment Center (CRC) collaborate to establish the correct payment order between a person's two insurers and to recover funds if payments were managed incorrectly. Understanding this process can help inform people how their medical expenses are covered when they have both Medicare and private insurance. The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.
Yahoo
02-04-2025
- Business
- Yahoo
Tower MSA Partners Announces Strategic Investment from Ambler Brook to Accelerate Growth
DELRAY BEACH, Fla. & BOSTON, April 02, 2025--(BUSINESS WIRE)--Tower MSA Partners ("Tower"), a leading national provider of Medicare Secondary Payer ("MSP") compliance technology and settlement services to self-insured enterprises, insurance carriers and third-party administrators, announced today that it received a significant growth investment from Ambler Brook. Founded in 2011, Tower was launched with a vision to build a best-in-class integrated automation technology platform that simplifies MSP compliance, enhances the customer experience, and delivers measurable value to customers in a complex regulatory environment. Tower provides MSP services to national and global enterprises across industries, including Industrial, Manufacturing, Travel, Transportation & Logistics, Healthcare, Hospitality and Retail. "Ambler Brook's investment will enable us to accelerate growth, invest further in providing a superior product that ensures full MSP compliance and delivers cost-effective claim settlements through the use of artificial intelligence and other automation technology and expands our team of clinical and compliance experts who provide an unmatched level of customer service," said Kristine Dudley, Tower's Co-Founder and Chief Operating Officer. "We are excited to partner with the Co-Founders of Tower and the entire management team in this next phase of growth and innovation for the business. We identified Tower as part of our effort to find founder-owned businesses at the intersection of several investment themes, including cost containment, providers of mission-critical compliance solutions and automation technology," said Kearney Shanahan, Managing Partner of Ambler Brook. "The team has built a best-in-class MSP compliance solution that delivers a clear value proposition, commands a very loyal customer base and is highly scalable as the Tower management team executes on a growth-focused value creation plan," added Stephen Sahlman, Managing Partner of Ambler Brook. Choate, Hall & Stewart LLP served as legal advisor to Ambler Brook. Harbor View Advisors served as financial advisor and Trenam served as legal advisor to Tower MSA on the transaction. Eagle Private Capital and Resolute Capital Partners provided debt financing and a minority equity co-investment alongside Ambler Brook. The investment closed in the fourth quarter of 2024. About Tower MSA Tower MSA Partners, LLC, a leading provider of Medicare Secondary Payer ("MSP") compliance technology and services to the country's largest self-insured enterprises, carriers and third-party administrators. Tower's services include Section 111 Mandatory Insurer Reporting, conditional payment resolution, and Medicare Set-Aside optimization and preparation. Led by a management team with decades of regulatory and legal expertise, Tower's automation suite enables it to provide industry-leading compliance and regulatory solutions to facilitate fast, compliant, and cost-effective savings for its clients. To learn more about Tower MSA Partners, please visit: About Ambler Brook Ambler Brook is a thesis-oriented investment firm focused on investing in founder-owned Healthcare and B2B businesses. The firm partners with founders and management teams to build market leading businesses through the implementation of bespoke value creation initiatives that accelerate organic and M&A growth over the long-term in lower middle market businesses. Ambler Brook invests in both services and technology businesses with <$15M of EBITDA. To learn more about Ambler Brook, please visit: View source version on Contacts Media Contact: Dan AndersChief Compliance Officer, Tower MSA
Yahoo
02-04-2025
- Business
- Yahoo
Inc. Names Sanderson Firm to Its 2025 List of the Fastest-Growing Private Held Companies
BRADENTON, Fla., April 2, 2025 /PRNewswire/ -- Inc., a leading media brand for entrepreneurs and business leaders, announced today that Sanderson Firm PLLC is No. 2 on its list of the fastest-growing private companies in the Southeast region of the country. An extension of the national Inc. 5000 list, the Inc. Regionals list offers a unique look at the most successful companies within the Southeast economy's most dynamic segment–its independent small businesses. Complete results of the Inc. Regionals: Southeast, including company profiles, can be found at "It has been a dream come true for Sanderson Firm to have the prestigious honor of being ranked by Inc. as the second fastest growing privately held company in the Southeast region of the country. The growth that we have achieved is something I could have never imagined. I am grateful for the support of the Medicare Secondary Payer industry, our nationwide client base, as well as our excellent team members for helping us achieve this milestone," said Heather Sanderson, Sanderson Firm's Chief Executive Officer. "The honorees on this year's Inc. Regionals list are true trailblazers driving economic growth in their respective regions, industries, and beyond. This list celebrates their achievements and tells the stories of remarkable companies that are fueling growth and adding jobs in local economies throughout the country," said Bonny Ghosh, editorial director at Inc. About Sanderson Firm: Sanderson Firm specializes in Medicare Secondary Payer (MSP) services and is proud to be a woman owned business. Our team of legal and clinical professionals have more than 400 years of combined experience in the MSP industry, and we are proud to serve as trusted counsel and MSP compliance services vendor to some of the nation's most well-recognized insurance carriers, self-insured companies, and third-party administrators, as well as smaller, regional insurance carriers and governmental entities. About Inc. and the Inc. Regionals and Methodology: The 2025 Inc. Regionals are ranked according to percentage revenue growth over two years. To qualify, companies must have been founded and generating revenue by March 31, 2021. They had to be U.S.-based, privately held, for-profit, and independent—not subsidiaries or divisions of other companies—as of December 31, 2023. The minimum revenue required for 2021 is $100,000; the minimum for 2023 is $1 million. For media inquiries, please contact David Sunderhaus, Marketing Specialist at 9419938220 or 392707@ View original content to download multimedia: SOURCE Sanderson Firm
