Lavonya Chapman, Esq, RN, CMSP

Biography

Attorney, Claim Director, and Registered Nurse with over 25 years experience handling all types of commercial claims to include workers compensation, auto med pay, auto liability, general liability, premises liability, bodily injury, professional liability claims and lawsuits which involved Medicare eligible claimants and Medicare beneficiaries.
 
Qualifications/achievements include:
 Verifying Medicare and Social Security Disability eligibility
Evaluating files to determine causal connections to claimed injuries, utilization & medical necessity of medical services
Reviewing conditional payments for relatedness and to avoid becoming primary payer
Disputing and appealing conditional payment recovery asserted by Medicare and Dept. of Treasury
Determining if future medical expenses are covered by Medicare
Allocating future medical expenses anticipated based upon rated age of claimant, ICD-9/10 codes, medical records, and medications prescribed
Calculating future medical cost projections
Assigning ICD injury/illness codes consistent with medical records and allegations claimed and released
Interacting with Coordination of Benefits Contractor (COBC) and Medicare Secondary Payer Recovery Contractor (MSPRC), CMS’ Benefits Coordination & Recovery Center (BCRC), or Commercial Repayment Center (CRC), and various Medicare Advantage plans (MAPs)
Reviewing Medicare Set-Aside Arrangements
Reporting claims to The Centers for Medicare and Medicaid Services (CMS) pursuant to Section 111 mandatory insurer reporting requirements (MIR)Reviewing and drafting settlement language to illustrate protection of Medicare’s 

Professional Experience
Claim Compliance Director, Arthur J Gallagher & Co.                                  2010-2014
Medicare Fraud & Abuse Subcontractor, Kelley & Associates                      2007-2014
Claim Director, Arthur J Gallagher & Co.                                                         2000-2010
Attorney, Gaines, Wolter & Kinney and McFerrin & Assocs.                        1996-2000                             
Workers Compensation Medical Case Manager, USF&G Ins.                       1991-1996
Utilization Reviewer, Alabama Hospital Association                                    late 1980s   (4-5 years)
Pharmacology Instructor, University of Alabama at Birmingham               early 1980s (8 years)

Education

No information available.

Admissions/Licenses

• Bar Admissions: AL, FL