Presenting a live 90-minute webinar with interactive Q&A Workers' Compensation Claims and the Medicare Secondary Payer Act Meeting Reporting Requirements, Satisfying Liens, and Establishing Set-Asides in Settlements WEDNESDAY, FEBRUARY 1, 2017 1pm Eastern | 12pm Central | 11am Mountain | 10am Pacific 1pm Eastern | 12pm Central | 11am Mountain | 10am Pacific Today’s faculty features: John V. Cattie, Jr., Founding Member , Cattie , P.L.L.C . , Charlotte, N.C. The audio portion of the conference may be accessed via the telephone or by using your computer's speakers. Please refer to the instructions emailed to registrants for additional information. If you have any questions, please contact Customer Service at 1-800-926-7926 ext. 10 .
Tips for Optimal Quality FOR LIVE EVENT ONLY Sound Quality Sound Quality If you are listening via your computer speakers, please note that the quality If you are listening via your computer speakers, please note that the quality of your sound will vary depending on the speed and quality of your internet of your sound will vary depending on the speed and quality of your internet connection. connection. If the sound quality is not satisfactory, you may listen via the phone: dial If the sound quality is not satisfactory, you may listen via the phone: dial 1-866-869-6667 and enter your PIN when prompted. Otherwise, please 1-866-869-6667 and enter your PIN when prompted. Otherwise, please send us a chat or e-mail sound@straffordpub.com immediately so we can send us a chat or e-mail sound@straffordpub.com immediately so we can address the problem. address the problem. If you dialed in and have any difficulties during the call, press *0 for assistance. If you dialed in and have any difficulties during the call, press *0 for assistance. Viewing Quality Viewing Quality To maximize your screen, press the F11 key on your keyboard. To exit full screen, To maximize your screen, press the F11 key on your keyboard. To exit full screen, press the F11 key again. press the F11 key again.
Continuing Education Credits FOR LIVE EVENT ONLY In order for us to process your continuing education credit, you must confirm your In order for us to process your continuing education credit, you must confirm your participation in this webinar by completing and submitting the Attendance participation in this webinar by completing and submitting the Attendance Affirmation/Evaluation after the webinar. Affirmation/Evaluation after the webinar. A link to the Attendance Affirmation/Evaluation will be in the thank you email A link to the Attendance Affirmation/Evaluation will be in the thank you email that you will receive immediately following the program. that you will receive immediately following the program. For additional information about continuing education, call us at 1-800-926-7926 For additional information about continuing education, call us at 1-800-926-7926 ext. 35. ext. 35.
Program Materials FOR LIVE EVENT ONLY If you have not printed the conference materials for this program, please If you have not printed the conference materials for this program, please complete the following steps: complete the following steps: Click on the ^ symbol next to “Conference Materials” in the middle of the left- Click on the ^ symbol next to “Conference Materials” in the middle of the left- • hand column on your screen. hand column on your screen. Click on the tab labeled “Handouts” that appears, and there you will see a Click on the tab labeled “Handouts” that appears, and there you will see a • PDF of the slides for today's program. PDF of the slides for today's program. Double click on the PDF and a separate page will open. Double click on the PDF and a separate page will open. • Print the slides by clicking on the printer icon. Print the slides by clicking on the printer icon. •
5
Workers’ Workers’ Workers’ Workers’ Compensation Claims Compensation Claims Compensation Claims Compensation Claims and the Medicare and the Medicare and the Medicare and the Medicare Secondary Payer Act Secondary Payer Act Secondary Payer Act Secondary Payer Act 6
Medicare Secondary Payer – A Medicare Secondary Payer – A I. I. Statutory Analysis Statutory Analysis II. MMSEA Section 111 II. MMSEA Section 111 MMSEA Section 111 MMSEA Section 111 II. II. III. Conditional Payments III. Conditional Payments Conditional Payments Conditional Payments III. III. IV. Future Medicals and MSAs IV. Future Medicals and MSAs Future Medicals and MSAs Future Medicals and MSAs IV. IV. V. MSP Changes in 2017 V. MSP Changes in 2017 MSP Changes in 2017 MSP Changes in 2017 V. V. 7
Medicare Secondary Payer – A Statutory Medicare Secondary Payer – A Statutory I. I. Analysis Analysis A) Conditional Payments A) Conditional Payments B) Medicare Set-Asides B) Medicare Set-Asides C) MMSEA Section 111 Reporting C) MMSEA Section 111 Reporting Common theme = Common theme = Was Claim Accepted or Denied? Was Claim Accepted or Denied? 8
MSP – A Statutory Analysis “Payment under this subchapter may “Payment under this subchapter may not be made, except as provided in not be made, except as provided in subparagraph (B), with respect to any subparagraph (B), with respect to any item or service to the extent that – item or service to the extent that – payment has been made or can payment has been made or can reasonably be expected to be made reasonably be expected to be made under a workmen’s compensation law under a workmen’s compensation law or plan of the United States or a State or plan of the United States or a State …” …” 42 U.S.C. § 1395y(b)(2)(a)(ii) 42 U.S.C. § 1395y(b)(2)(a)(ii) 9
MSP – A Statutory Analysis “Payment under this subchapter may “Payment under this subchapter may not be made, except as provided in not be made, except as provided in subparagraph (B), with respect to any subparagraph (B), with respect to any item or service to the extent that – item or service to the extent that – payment has been made or can payment has been made or can reasonably be expected to be made reasonably be expected to be made under a workmen’s compensation law under a workmen’s compensation law or plan of the United States or a State or plan of the United States or a State …” …” 42 U.S.C. § 1395y(b)(2)(a)(ii) 42 U.S.C. § 1395y(b)(2)(a)(ii) 10
MSP – A Statutory Analysis “Payment under this subchapter may “Payment under this subchapter may not be made, except as provided in not be made, except as provided in subparagraph (B), with respect to any subparagraph (B), with respect to any item or service to the extent that – item or service to the extent that – payment has been made or can payment has been made or can reasonably be expected to be made reasonably be expected to be made under a workmen’s compensation law under a workmen’s compensation law or plan of the United States or a State or plan of the United States or a State …” …” 42 U.S.C. § 1395y(b)(2)(a)(ii) 42 U.S.C. § 1395y(b)(2)(a)(ii) 11
MSP – A Statutory Analysis “Payment Reasonably “Payment Has Been Expected To Be Made” Made” Past Future Medicals Medicals 12
MSP – A Statutory Analysis “ … an applicable plan shall – “ … an applicable plan shall – (i) Determine whether a claimant (including an (i) Determine whether a claimant (including an individual whose claim is unresolved) is entitled individual whose claim is unresolved) is entitled to benefits under the program under this to benefits under the program under this subchapter on any basis; and subchapter on any basis; and (ii) If the claimant is determined to be so entitled, (ii) If the claimant is determined to be so entitled, submit the information described in submit the information described in subparagraph (B) with respect to the claimant to subparagraph (B) with respect to the claimant to the Secretary in a form and manner (including the Secretary in a form and manner (including frequency) specified by the Secretary.” frequency) specified by the Secretary.” 42 U.S.C. § 1395y(b)(8) 42 U.S.C. § 1395y(b)(8) 13
MMSEA Section 111 MMSEA Section 111 14
II. II. MMSEA Section 111 MMSEA Section 111 A) What Triggers MMSEA Section 111? A) What Triggers MMSEA Section 111? B) Reporting Nuts & Bolts B) Reporting Nuts & Bolts C) Low Dollars Thresholds C) Low Dollars Thresholds 15
MMSEA Section 111 Who Must Report? Who Must Report? “Information is to be reported for claims related “Information is to be reported for claims related to liability insurance (including self-insurance), to liability insurance (including self-insurance), no-fault insurance, and workers’ compensation no-fault insurance, and workers’ compensation where the injured party is (or was) a Medicare where the injured party is (or was) a Medicare beneficiary and medicals are claimed and/or beneficiary and medicals are claimed and/or released or the settlement, judgment, award, or released or the settlement, judgment, award, or other payment has the effect of releasing other payment has the effect of releasing medicals.” medicals.” User Guide v. 5.2, Chapter 6.5.1 User Guide v. 5.2, Chapter 6.5.1 16
Recommend
More recommend
