Litigation, collection calls and letters and working closely with service providers are enforcement measures used by these providers.
What is a subrogation attorney?
100
This is a common-law method by which a health insurance carrier can pursue its right of recovery. This can occur even in the absence of and express written contract between the member and the health plan.
What is Equitable Subrogation?
100
A type of clause indented to give the subrogee rights to _________ of the insured and pursue an action directly against the tortfeasor.
What is "Stand in the Shoes?"
100
The three categories of no fault laws.
What is Pure, Modified and Expanded or add-on No fault?
100
Five different types of statements.
What is oral, recorded, negative, written and Examinations under oath(testimony)?
200
Information that should be included on this such as: specific descriptions of fees to be charged to the client and the services rendered by the service provider.
What is subrogation service provider contract?
200
This form applies only to FEDERAL health plans and Medicare recovery rights granted by federal statutes.
What is Statutory Subrogation?
200
The two arguments that an injured party, or the injured party's attorney, will use to reduce the amount owed back to the health plan.
What is the made whole rule and common fund doctrine?
200
This no fault subrogation state is most often allowed.
What is Common Law State?
200
A location when the 'rules of the road' do not apply in determining liability.
What is a parking lot/private property?
300
The client pays the same fee for each claim or referral regardless of the results.
What is fixed fee?
300
This is the most recognized form of healthcare subrogation and is allowed in most states.
What is Conventional subrogation?
300
This gives CMS (Center of Medicare and Medicaid Services) the right to pursue all other parties when Medicare pays health claims that should be paid by any other party.
What is Medicare Secondary Payer Act?
300
The reasons people were dissatisfied with the tort system prior to no fault.
What is over compensation for minor injuries, under compensation for severe injuries and delayed payment of losses.
300
The requirements for a products liability claim.
What is a duty owed, a duty breached, the breach as the cause of loss and damages.
400
Due to the high volume of these claims clients often grant settlement authority in advance to settle without the client express approval.
What is uninsured motorist claims?
400
Employment-based health insurance accounts for more than 55% of the coverage in the US. They are governed by this:
What is the Employee Retirement Income Security Act of 1974 aka ERISA.
400
These are the two main ways of recovery for a health plan when dealing with Workers compensation claims.
What is direct recovery from the WC carrier and recovery from a provider that has been paid by both the health plan and WC carrier?
400
These exclusions are listed for both auto and homeowner medical payments coverage. (hint there are 2)
What is Acts arising out of war/nuclear reactions and acts that are covered by work comp?
400
The year the National Association of Subrogation Professionals was established.
What is 1998?
500
The three most common recovery procedures.
What is negotiation, intercompany arbitration and litigation?
500
These are the six main types of health plans.
What is Medicaid, Medicare, FEHBA, ERISA, Church/other governmental and Individual plans?
500
This is what a FEHBA plan contain that an ERISA plan does not. (Hint it is a clause)
What is Preemption clause?
states that FEHBA preempts state law in the area of federal employee health insurance plans.
500
When allowed, subrogation of no-fault benefits serves these two purposes:
What is to prevent double recovery and to shift cost to the non-contributors or under-contributors?
500
This type of arbitration the parties agree in advance to a maximum and minimum award.