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  1. Thinking Outside The Box: Litigation management program initiatives can substantially lower costs February 25, 2010

    Posted in Litigation Management, SPOT on Costs.

    Managing litigation is an easy way to save extra expense costs on claims files. A strong litigation management program designed to help foster improved communication, and streamline defense of insureds, benefits all parties involved. As I wrote about the cost savings benefits of out-of-the-box claims handling, using new and forward thinking strategies for litigation management is an excellent way to save money. Using specialized vendors, claim handlers can further control legal costs as well as enhance their defense.

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  2. 3 Essential Report Types That Insurance Executives Should Use To Analyze Their Claims February 23, 2010

    Posted in SPOT on Ops.

    Today’s modern claims systems have a wealth of knowledge about every aspect of claims operations. With the right reports it should be easy to get a basic snapshot of how effective your claims are being managed, and how well your business is doing. With all that information where is one to start? What are the key metrics that should be reviewed by claims and business executives to better understand their operations? We give three specific report types that claims executives should review on a regular basis to get a valuable snapshot of their organization.

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  3. Important Update: Medicare Secondary Payer changes production date to January 1, 2011 February 18, 2010

    Posted in Medicare Secondary Payer, SPOT on Issues, SPOT on Ops.

    The Centers for Medicare/Medicaid Services (CMS) have announced the following: CMS advises all NGHP RREs that the date for first production NGHP Input Files is changed from April 1, 2010 to January 1, 2011, effective immediately. Read the complete announcement at the CMS website in “What’s New.” This is clearly a welcome change and one […]

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  4. Absence of procedures to notify reinsurance is a basis for bad faith February 17, 2010

    Posted in Bad Faith, Best Practices, SPOT on Issues.

    Recently I was discussing bad faith and notice procedures with attorney Phil Loree Jr., an expert on reinsurance and arbitration issues and author of the the Loree Reinsurance and Arbitration Forum blog.  I thought this was a timely conversation as it reinforced the concepts regarding procedures and the potential risks when they are not in […]

  5. 5 Claims issues cited for non-compliance on market conduct exams & 3 tools to avoid them February 15, 2010

    Posted in Best Practices, Compliance, SPOT on Issues, SPOT on Ops.

    Insurance Market Conduct examinations are a regular part of the insurance business. Besides the stress of the exam itself, being cited for violations can result in costly fines. Regardless, many citations can be avoided. Every year, insurance compliance solutions provider Walters Kluwer releases its annual study of top ten reasons insurance companies are found to […]

  6. Blizzard Warning in the East! Can your claims department keep running if the office closes? February 10, 2010

    Posted in SPOT on Ops.

    The East Coast snow storm is a great reminder to be prepared for disasters and other reasons why your office would have to close. Do you have the plans in place to manage the next event? Does your claims system give you the ability to manage claims remotely? Can you manage claims remotely for an extended period of time?

  7. Improve bottom-line outcomes on claims by thinking outside-the-box! February 9, 2010

    Posted in Best Practices, SPOT on Issues.

    Claim handling is just as much an art as it is a science. Synthesizing facts and investigating losses requires, not only following process and procedures, but also the ability to look at new ways of solving established problems. Following best practices is of course an effective way to achieve consistently good claims results. Regardless, the […]

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  8. Med Mal Update: Reasons for decrease in frequency and recent Illinois court decision to strike down damage caps February 5, 2010

    Posted in Medical Malpractice, SPOT on Issues.

    In response to my post, medical malpractice report shows increased severity despite lower frequency, I received a number of LinkedIn comments that I felt offered an interesting perspective on this topic. I have included some of that discussion below. Additionally below, I review the news that the Illinois Supreme Court has struck down that state’s […]

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  9. Warning – Medicare Secondary Payer (MSP): Government sends strong message and goes after non-compliance February 3, 2010

    Posted in Medicare Secondary Payer, SPOT on Ops.

    If you are an insurance company or self-insured, and make payments on liability or workers’ compensation claims, be aware that the Federal Government has filed a lawsuit signaling their intent to be aggressive in seeking reimbursement. As reported in Business Insurance, this “case breaks new ground because CMS simultaneously named insurers, settlement beneficiaries and plaintiffs attorneys all in one lawsuit.” This case should alert all that if you make a payment on an injury claim, and fail to let the Government know about money they should be collecting, they will come after you.

  10. Failing to properly document files can be costly – It cost one insurance agency $5.83 Million February 1, 2010

    Posted in Best Practices, Commentary, SPOT on Ops.

    Files should speak for themselves. A recent California decision is yet another example of what can happen if you don’t document your files and maintain procedures. In this case – it cost $5.83 million.

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