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Study finds evidence of post-settlement Medicare treatment denials

Posted On: Jan. 20, 2022 1:24 PM CST


A study published Thursday by Ametros Financial found that over 34,000 claims per year were denied to Medicare beneficiaries’ post-settlement because Workers Compensation Medicare set aside funds were responsible for the payments.

The study was conducted in collaboration with the Research Data Assistance Center, a Centers for Medicare and Medicaid Services contractor that assists researchers, to analyze Medicare Part B claims data from 2018-20.

Examining a random sample of 5% of the Medicare beneficiary population over a three-year period, researchers estimate Medicare denied 35,980 WCMSA claims in 2018, 36,060 in 2019, and 30,720 in 2020 because each individual’s WCMSA account should have paid the claims, the study states.

In a statement, Ametros CEO Porter Leslie called the study findings “a wake-up call” for everyone involved in settlements.