Medicare

MMSEA Section 111 requires the reporting of claim information to the Centers for Medicare and Medicare Services (CMS) in cases where the injured party is a Medicare beneficary. Davis Risk Services, (www.davisrisk.com) claims management system will provide fields for data collection, transmission of quarterly claim files, retrieval and processing of response files and submissions of monthly Query files.

Set up of each RRE ID includes specifying DRS as an account designee for data transmissions, set up of the RRE ID in DRS’ claim management system, implementing the testing process required by CMS per RRE ID for both the Query and claim files and coordinating with the client to designate all of the claims that the client wishes to query for eligibility in an initial Query file.

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Howell vs. Hamilton Meats & Provisions, Inc.

In Howell v. Hamilton Meats & Provisions, Inc., plaintiff sustained injuries in a vehicle accident caused by the negligent driving of defendant’s employee. The trial granted defendant’s motion to reduce by $130,286.90 a jury’s special verdict award for plaintiff’s past injury-related medical related expenses to $59,691.73. The appeals court reversed and remanded stating that in a personal injury case in which the plaintiff has private health care insurance, the negotiated rate differential is a benefit within the meaning of the collateral source rule, and thus the plaintiff may recover the amount of the differential as part her recovery of economic damages for the past medical expenses she incurred for care and treatment of her injuries.
The Howell court disagreed with the earlier appellate decisions (Nishihama/Hanif), and ruled that the amount of medical expenses written off by the medical providers was to be awarded to the plaintiff by application of the collateral source rule. The collateral source rule applies when an injured party obtains compensation for medical expenses from an independent source. Application of the rule results in a plaintiff being awarded the amount of money paid for example, by the plaintiff’s health insurer, notwithstanding the fact that the plaintiff did not pay that money. The Howell court’s application of the collateral source rule allows the plaintiff to be paid money for “medical expenses” over and above what her insurance carrier paid to fully compensate her medical providers for their expenses.
The Howell opinion distinguished the Hanif decision by noting that the plaintiff in Hanif was a Medicare beneficiary and, as such, had no legal obligation to pay the amount originally billed by that plaintiff’s medical providers. The Howell decision does not explain how the plaintiff is in any different position once the decision had been made by her medical providers to write-off the amount that she had previously been obligated to pay them.
The Howell opinion disagreed with the Nishihama decision by noting that this former case focused on the fact that the medical provider’s lien rights in that case were extinguished once it agreed to accept payment from the medical insurer in full as well as because the Nishihama opinion did not conduct an analysis of the collateral source rule.
The Howell decision is not binding authority until after the time to request review by the Supreme Court expires. It would not be unreasonable to believe that such review would be granted given that opinion’s stated disagreement with the Nishihama decision.

ADJ. Mediation Services

It is the job of a mediator to mediate-help disputing parties find a resolution to their case.  It is not the job of the mediator to practice law or make decisions or findings. 

With my experience as a mediator, I am successful in making parties comfortable so that they can freely discuss their issues.  Confidential open communication is the key to a successful mediation. 

I have been trained in conflict resolution and in working with difficult situations at Pepperdine University School of Law.  Over the years, I have found I am able to work as much with the emotional aspects and relationship aspects of a case as I work on the “topical” issues of the matter.

 

Part of my role is to help the parties think “outside of the box” for possible solutions to the dispute, thus enabling the parties to find the avenue to dispute resolution that suits them best.

ADJ. Mediation Services

FAMILY LAW MEDIATION

 

Mediation not Retaliation

 

 

No one begins their married life thinking of dividing assets and liabilities, alimony payments, child support or visitation arrangements. Divorce is not a failure. There are many reasons for divorce and the reasons are never the same. In a family situation where divorce is the last resort, as difficult as it is, in today’s economy, do it quickly and economically.

 

For every action there is NOT an equal and opposite reaction. Divorce is NOT the equal and opposite reaction to marriage. Regardless of the reason a marriage ends, the cost of a divorce can be far greater in terms of family unity, health, and wealth if it is viewed as a battle with a clear winner. In a divorce, no one wins and everyone must compromise.

 

Don’t make a divorce the end of the world. Approaching it as a battle will ensure that the costs will be greater than any benefit you expect. The longer the process of the divorce takes, the longer it will hurt and the more expensive it will be…guaranteed! 

 

Weather you are going through the process with or without an attorney, it is key that cost savings is a primary consideration during the process.

 

How Does Mediation Work?

 

Mediation is a voluntary process which enables the parties to stay in control and make their own decisions regarding their family’s future rather that leaving their fate to a Judge who knows nothing about the parties and their family. Since it is completely voluntary, you may withdraw from the mediation at any time.

 

The mediation process allows you to agree on the important decisions together in order to arrive at a settlement agreement which is fair and equitable and acceptable to both parties. All discussions are conducted by an experienced and trained mediator in the privacy and comfort of the mediator’s office without ever having to go to court.

 

The mediator is a neutral party who, quite simply, assists the parties with negotiations. The mediator does not represent or make decisions for any of the parties. The mediator encourages and helps the parties clarify any unresolved issues, to generate options and to find solutions that are acceptable to all the parties.

 

Additional Points to Consider.

 

COST

 

Parties to a dispute may choose mediation as (often) a less expensive rout to follow for dispute resolution. While a mediator may charge a fee comparable to that of an attorney, the mediation process takes much less time than moving a case through litigation. While a case in the hands of a lawyer or filed in court may take months or even years to resolve, a case in mediation usually achieves a resolution in a matter of hours (or days). Taking less time means expending less money on attorney’s hourly fees and costs.

 

CONFIDENTIAL

 

Mediation, by law in Los Angeles County in California, is a confidential process. While court hearings of cases are open to the public along with court records, whatever happens in mediation remains strictly confidential. No on but the parties to the dispute, their attorneys (if applicable) and the mediator know what has gone on in the mediation hearing. 

 

In fact, confidentiality in mediation has such importance that the legal system cannot force a mediator to testify in court as to the content or progress of a mediation. Many mediators actually destroy their notes taken and documents received during a mediation once that mediation has finished. 

 

NEUTRAL PARTY

 

Finally, but certainly not least, and as mentioned earlier in this article, the mediation takes place with the aid of a mediator who is a neutral third party. A good mediator is trained in conflict resolution and in working with difficult situations. The good mediator is likely to work as much with the emotional aspects and relationship aspects of a case as he or she is to work on the “topical” issues of the matter.

 

The mediator, as a neutral, gives no legal advice, but guides the parties through the problem solving process. The mediator may or may not suggest alternative solutions to the dispute. Whether he or she offers advice or not, the trained mediator helps the parties think “outside of the box” for possible solutions to the dispute, thus enabling the parties to find the avenue to dispute resolution that suits them best.

 

CONCLUSION

 

Tragically, too many mediations take place after several thousand dollars in legal fees have already been spent preparing for trial. By this time, most parties are quite aggravated with each other. Doesn’t it seem logical that the first step be mediation?

 

So, what is the truth about divorce mediation vs. litigation? It is an important question, with no “one-size-fits-all” answer. For most couples, mediation easily bests the scorch and burn, “War of the Roses”, winner-take-all, lawyer fought, custody battle litigated approach to divorce!