Medicare Lien Enforcement - Making a List, Checking it Twice

Parties to personal injury claims of Medicare beneficiaries who continue ignoring their duties to the federal government could get a wake up call next year. Like Santa, Uncle Sam is making a list and checking it twice; going to find out who's naughty and nice.The Centers for Medicare and Medicaid Services (CMS) apparently believes that the parties to personal injury claims of government healthcare beneficiaries are neglecting to meet their duties under federal law. Such as the duty to report the claim. And the duty to reimburse Medicare for payments it made for medical treatment arising out of the injury underlying the claim.Around Christmas 2007 Congress passed and President Bush signed into law Public Law 110-173, the Medicare, Medicaid and SCHIP Extension Act of 2007, now frequently referred to as the Mandatory Insurer Reporting law (or MIR) - 42 USC sec. 1395y(b)(7) and (8). Under the new law group health, workers' compensation, liability and no fault insurers and self-insurers will be required to provide information to CMS-beginning in 2009- on each claim of a Medicare, Medicaid or SCHIP beneficiary. Triggers for reporting include a decision to honor a claim and issuance of a check to pay a settlement, judgment or award.Once that reporting is done, CMS will have a quick and easy list of which of its beneficiaries received a settlement for an injury claim, what type of injury was suffered and who the settling party was. That will be very helpful information, making it easy to determine:o Whether CMS made any payments for treatment of that same injury, ando Whether the parties to the settlement made arrangements to reimburse CMS for any payments it made for that treatment, ando If no reimbursement was made, who CMS can go after to get reimbursement, ando Who CMS can go after to collect the penalties ($1,000 per claim per day's delay in reporting and double damages for failing to reimburse conditional payments.)Even before the December 2007 amendment to the Medicare Secondary Payer law, Congress made clear it was not going to listen to any quibbling about lack of liability on the underlying personal injury claim. Under the existing law, if an insurer or self-insured enters into a settlement of the personal injury claim, that insurer/self-insured is primary to Medicare for medical expenses related to that injury.Uncle Sam is looking for a little cash to help fund the Medicare trusts, and with the new reporting that will start in 2009, he is expected to have no trouble finding lots of new pockets to dip into to help keep those trusts going.

What to Expect When You Start a Home-Based Business

There are many advantages and disadvantages from starting your own business and working from home. Some the advantages are fairly obvious such as a very short commute time and the freedom to organize your work at times that suit you. This flexibility enables you to determine the amount of time that you're going to spend at work and how you are going to fit it in with your own family commitments. This means that if you are a parent that works at home, you can take your children to school and collect them at the end of the school day. If they are sick you can stay at home with them and if necessary take a day off from your work without having to answer to anyone. Probably the greatest advantage is that you are not bound by policies and practices that inhibit your freedom. Your start up capital for a home-based business is much less than a conventional one and your income is not limited by fixed salaries. Furthermore there are tax advantages that accrue from running a home-based business.There are disadvantages of working from home because it's necessary to have a high degree of planning and self-discipline. You will need the skill and planning to make the best use of your time because it is sometimes hard to manage the family interruptions when you are working. Self discipline is another factor that looms large for the person that works at home. It's very easy to spend a lot of time on the telephone because there is the social interaction that is available in the normal workplace. Working at home can sometimes be a lonely experience where you feel cut off from the rest of the world and spend too much time compensating by surfing the net.After working at home for 37 years, I have found that working in blocks of time suit me best. I will plan to work in a two-hour block and have a five minute break after each hour. Setting goals and targets is also an essential part of the home worker's regime. By setting goals and targets and milestones it is possible to be very productive if you are able to limit the interruptions that you create for yourself or occur through family members.No matter what type of work you do at home, you will need to understand how to market your products and services. This is the area where most new home workers struggle. The marketing of your products and services is an active rather than a passive process that continues relentlessly in times of high sales and low sales. The success of most people who work at home is a reflection on their ability to market their products. My advice to anybody contemplating a home-based business is to sharpen up your marketing skills so that you are in a position to promote your business from day one.

Workers' Compensation In California

The concept behind modern workers' compensation laws, that employers should provide for their employees in the event of injury, can be traced as far back as ancient Babylon where both employers and slave masters were required by law to pay for their workers' medical care in the event of illness or injury.The modern concept of workers' compensation developed during the Industrial Revolution in Europe in the 19th century. The concept crossed the Atlantic, and today, every State and territory has such laws in place, including the Federal government.Before the enactment of California's workers' compensation laws, injured workers were required to file common civil law suits against their employers in order to recover damages to pay for economic losses and medical treatment. Injured workers had the burden of proving their employer's fault, and employers were allowed to raise normal civil defenses such as contributory negligence of the worker, assumption of risk by the worker, and fellow-servant causation.If the worker failed to prove that the employer caused the injury, the worker recovered nothing. If the employer could prove that the worker's own negligence or that the actions of a fellow employee caused the injury, the worker recovered nothing. Or, if the employer could prove that the worker understood and assumed the risks involved in the job, and the worker was injured as a result of these dangers, the worker recovered nothing.California's workers' compensation laws were first developed in the early 1900's and were codified by the Boynton Act of 1913. Although there have been many amendments and reforms to these laws over the years, the basic principles have remained the same - that California workers are entitled to medical treatment and compensation payments for industrial injuries.Today, California's workers' compensation system is a "no-fault" system of recovery. Instead of having the burden of proving the fault of your employer in causing your injury, now you simply have to show that your injury arose out of and occurred during the course of your employment in order to present a legitimate claim. In turn, your employer can no longer assert the defenses of contributory negligence, assumption of risk, or the fellow-servant doctrine.DISCLAIMER: Please keep in mind that this article is intended for informational purposes only and does not constitute legal advice. You are expressly advised to seek legal counsel if you have questions about your particular workers' compensation claim.

Understanding Temporary and Permanent Disability

The workers' compensation system is intended to help injured employees address the financial effects of a workplace injury. As such, it is designed to serve as a temporary measure that fulfills a very specific set of needs for an injured worker and his or her family. But in instances where one suffers from an illness or physical ailment that leaves them unable to work for a significant length of time, it is instead the Social Security Disability Insurance system that supplies the necessary relief. The two primary forms of disability are Temporary Partial Disability and Permanent Total Disability.Since the determinations regarding benefits are made by a government agency, the bureaucratic hoops through which a disabled person must jump are considerable. The filing process is lengthy, and the vast majority of claims are denied upon receipt and review of the initial application for benefits. Commonly, these rejections are due to minor procedural and clerical errors of the submitted claim. But although they can be easily corrected once the problems are drawn to your attention, it still may delay the final approval and distribution of benefits for months, forcing your family to dig deep into savings if you have them.The Quirks of the Filing ProcessOne key distinction between the workers' compensation system and the SSDI benefits scheme as that eligibility for SSDI benefits does not require that your injury have been sustained in the workplace or in the performance of work related tasks. This is a fact that is often confused by workers who are unfamiliar with the structures in place to protect them if they become seriously hurt and one that is essential to ensuring that the appropriate steps are taken in the time allotted by the law. Some important statistics about the disability process to bear in mind are:
Approximately 30 % of claims are initially approved
15 % more are approved upon application for reconsideration
Nearly 60 % of claims that reach the hearing phase after appeals are approved
It can be more than 18 months from your initial filing until a final determination is made The length of anticipated disability, as well as the rated degree of disability ascertained through a formal medical evaluation with an approved physician, determines how long you can receive benefits and at what level you will be compensated for them. Temporary benefits are available when there is an expectation that you will be unable to work for a year or more, and permanent benefits are available when there is no likely recovery.For Help with Your FilingTo prevent costly filing errors and to present the strongest case possible, it is advisable to work with a skilled and experienced attorney. Contact the Raleigh disability lawyers of Scudder & Hedrick, P.L.L.C., to take the next step.

Seven Reasons Why You Should Quit Contracting and Find Another Job

I've been a licensed general building contractor for over 20 years now and have been working in the construction business since 1978. I don't know how many times I've thought about quitting, but haven't yet.1. You're tired of working for abusive clients. I don't know how many people I've actually worked for that have emotional and mental problems. Some of them were pretty abusive people.2. Nobody pays you on time anymore. If you're a contractor who works for other contractors, you know what I'm talking about. I had to quit working for one contractor, because they wanted to start paying me every 90 days. It just doesn't make any sense.3. Workers compensation rates are going through the roof. I had to quit using workers in 2002, because I was paying over 50% of my payroll to the workers compensation insurance company.4. You're tired of going to estimates. There was a time when I got nine out of every 10 jobs that I went to look at and now it seems like I get about four out of every 10 jobs.5. You're tired of people telling you that you're ripping them off. I couldn't even afford medical insurance for the longest time, when I first started working as a contractor.6. You can't find good help. I probably had over a hundred people working for me at one time and out of those people, there were less than 10 of them that knew what they were doing.7. If you do find someone that knows what they're doing, they either quit or want more money. Life's not fair all of the time, but it isn't a reason to quit either.There might be seven reasons why you should quit contracting, but there are at least a hundred reasons why you should stay in the construction business. Don't let things like this get you down.

Understanding the Role of a Safety Management Consultant

Organisations interested in becoming licensed self insurers should consider enlisting the help of a safety management consulting company to assist with all stages of the application and assessment process. Self Insurance is the practice of taking on the responsibility and liability of underwriting, assessing and paying out worker's compensation claims in-house.In the right situation, this can prove a sound financial move for businesses but also carries with it a great deal of responsibility in terms of regulatory requirements and ongoing assessment. It also requires a sound understanding and practice of managerial programs within a company, all of which are subjected to intense and ongoing auditing procedures. All of this regulation can seem overwhelming, which is why bringing a safety management consulting company on board is a wise decision.What Does a Safety Management Consultant Do?A Safety Management Consulting company specialises in risk management. From an in-depth and up-to-date knowledge of OHS best practises to a deep understanding of legal requirements organisations face, to ongoing advice and consulting services on the implementation of management programs, safety management consultants are experts in the field and an excellent source of confirmation on all manner of questions organisations may encounter. A safety management consultant can also create customised industry specific OHS management programs which is an advantage both for meeting and maintaining self insurance assessment criteria.How To Choose A ConsultantOne of the easiest ways to find an excellent consultant is to network with other organisations who have had similar experiences and find out who comes highly recommended. If you have a particular problem you need help with it is advisable to choose a consultant based on their experience with similar situations, or alternatively to find a consultant or consultancy firm that specialises in your particular industry. References from other clients are a good benchmark, as are qualifications and membership to associations.The ProcessOnce you've enlisted the help of a quality safety management consulting firm, the way to proceed will be determined based on the specific requirements of your organisation. Whether you need advice on OHS management systems, need a system designed, or need to discuss certain challenges involved with either an application for or maintenance of a self-insurer's license, a detailed program will be discussed and decided upon and your consultant can advise you as to how to move forward.With something like self insurance, millions of dollars can be involved in small mistakes or oversights, and especially for an organisation unfamiliar with the often complex legislature, it is a wise investment to double-check decisions with a qualified and experienced consulting firm.

Outsourcing HR - Advantages of PEOs For Employers

Size does Matter:Companies that benefit most from using a PEO have anywhere from 10-100 employees. There are a few reasons why.· When a company has less than 100 employees, hiring a full-time, competent HR professional can be too costly to justify. Most PEOs employ HR professionals who are certified by the society for Human Resource management, and many with a Master's Degree. The cost: $60-$110k per year.· When a company has more than 100 employees, they begin entering the range where economies of sale(savings achieved by producing or buying large quantities of an item)work in their favor when purchasing health and worker's comp insurance.· When a company has less than 10 employees, they will struggle finding a PEO that will accept them into their medical plan.· If a company has less than 10 employees, and they DO get accepted into a PEO's medical plan, the cost savings provided via medical insurance doesn't have a profound effect on offsetting the PEO's fees.· When a company has less than 10 employees, Human Resources is not a large burden to deal with.White Collar Companies:White collar industries such as IT, professional services, and financial services usually must attract highly skilled employees, to do this they must compete with huge corporations that provide structured career paths, and great benefit packages.Professional Employer Organizations provide a great solution for this challenge; they will provide a benefit package comparable to that of a Fortune-500 firm, and they provide HR support that allows a small business to organize its employees' career paths in the same manner.We also find that with high-growth companies, they are simply moving too fast to sidetrack themselves with the administrative burden of managing HR issues in a manner that keeps them in compliance, and also allows them to attract top talent.Blue Collar Companies:In low-skill orientated blue collar businesses, attracting top talent is not the same priority it is in white collar companies. However, semi to high-skill blue collar companies have to compete for talent with unions, especially if part of the work force is already unionized. For this reason again, PEO benefit packages provide a great solution.Workers Compensation Insurance is usually a high cost item in blue collar industries that have riskier occupations, more important is how costly an accident in the workplace will be for the company's workers comp experience rating, which determines future premium amounts. Through coemploymenta PEO provides insulation against future premium increases should an accident happen. More importantly, the PEO will provide risk management solutions to safeguard the company from having a worker's comp claim in the first place. If an accident does happen they will fight all workers comp claims in court to prevent fraudulent claims, which are more prevalent in high risk occupations.Seasonal Companies:Seasonal industries with large fluctuations in the workforce benefit greatly from Professional Employer Organizations. This is largely due to the stability PEOs provide as far as state unemployment taxes.PEOs make periods with voluminous new hires or terminations very easy. They offer new hire support; including services such as job posting discounts, employee enrollment kits, background checks, drug screens, etc. For terminations, the most important facet is that PEOs will help companies do it in a manner which is in compliance with all regulations.Multi-State Employers: Small companies that operate with employees in multiple states or of those that can benefits the most from using a Professional Employer Organization. PEO's allow a company to seamlessly hire employees in various states without additional administrative burden. Here are a few reasons additional reasons why:· Each state has their own set of employment laws to comply with (example for CA, example for NY)· You must file for a state unemployment ID in each state· You must find worker's comp insurance in each state· Setting up a benefit package, complete with supplemental benefits, across state borders created tremendous administrative burdenA multi-state structure may limit the amount of PEOs you should consider in the shopping process; as many regionally based PEOs are not competitive with multi-state benefit plans, additionally they may not be accustomed to various state regulations.LLC's: Limited Liability Corporation is a popular structure in law firms, medical practices, or other companies with multiple owners/partners. This structure yields various advantages; however one of the drawbacks is that LLC partners can't be W-2 employees of the LLC.If partners are not employees, they're not entitled to unemployment benefits, nor can they participate in company medical insurance plans. Often LLC partners purchase health insurance individually, which is normally more expensive.Professional Employer Organizations offer a unique solution. Through coemployment, an LLC member can be a W-2 employee of the PEO without being an employee of the LLC. Often partners take a minimal salary from the PEO, enough so that they qualify to participate in company benefits, but the smaller the better in order to keep tax burdens low.