Pirates at the Settlement Conference Settling Cases and Complying with The Medicare Secondary Payer Act AGENDA 12:00 p.m. – 1:00 p.m. I. The Medicare Secondary Payer Act A. History and Applicability to Workers’ Compensation E. The New Treasure Map: Mandatory Insurer Reporting 1:00 p.m. – 2:00 p.m. II. Settlement Issues: Conditional Payments A. Defined E. Impact F. Compromise 2:00 p.m. – 2:15 p.m. BREAK 2:15 p.m. – 3:15 p.m. III. Settlement Issues: Taking Medicare’s Future Interests into Account A. Workers’ Compensation 1. The Origin of the Medicare Set-Aside B. The Medicare Set-Aside 1. Defined a. Gathering Information b. Analyze the Medical Records c. Project Future Medical Needs d. Determine Medicare Status e. Incorporating the Coding and Pricing f. Using a Rated Age g. Assembling the Report h. Submission i. Should a Single Individual Prepare the Medicare Set- 3:15 p.m. – 4:15 p.m. IV. Settlement Tactics and Shaping the MSA A. Analyzing the File and the MSA 1. Negotiation Process 2. Part D Issues a. Inclusion c. Donut Hole 3. Non-Medicare Covered Items 4. Waiver, Compromise and The $0 Set-Aside a. Legal Zero b. Medical Zero B. Liability Insurers 1. Applicability a. Be Proactive b. Analyzing Your Case for Purposes of Medicare 4:15 p.m. – 5:30 p.m. V. Closing the Deal – The Details A. Settlement Documents B. Approval 1. Workers’ Compensation 3. Due Process Concerns C. Funding Issues 1. Annuities / Structures 2. Seed Money 3. Separation of Funding D. Administration 4. Exhausting the Account a. Temporary Depletion E. Death of the Claimant
B. 2003 Medicare Modernization Act and Liability Insurers
C. The Evolution of the Act following Court Analysis
D. The MSP After the MMA
B. The Reach of CMS
C. Recovery Process
D. Time Limits to Seek Recovery
2. The Patel Memo
3. Thresholds
4. Settlement Tools – Sample Language
2. The Basic Medicare Set-Aside
Aside?
b. Average Wholesale Price
2. The Individual Tort Case
c. From the Defense Perspective
d. Adding Medicare as a Payee
2. Liability Cases
1. Considerations
a. Professional v. Self
b. Costs of Administration
2. Duties
3. Common Issues that Arise
a. Amount of Reimbursement Rates
b. Medicare Covered Items and Services
c. Services Received While Traveling
d. Taxes
e. Use of Funds Prior to Medicare Entitlement
f. Loss of Medicare Entitlement after Establishment of
an MSA
b. Permanent Depletion
The Medicare Set-Aside
Toolbox Training
I. Introducdtion
A. History of Medicare
B. The Financing of Medicare
C. System Overview
II. The Medicare Secondary Payer Act
A. History and Applicability to Workers’
Compensation
B. 2003 Medicare Modernization Act and
Liability Insurers
C. The Evolution of the Act following Court
Analysis
D. The MSP After the MMA
III. Knowing the Parties and Their Roles
IV. Overview of Workers’ Compensation
V. Overview of the Liability System
VI. Speaking the Language: The Acronyms
VII. The New Treasure Map: Mandatory Insurer Reporting
A. Responsible Reporting Entities (RRE)
B. Triggers
1. ORM: Ongoing Responsibility for
Medical
2. Settlement / Judgment / Award /
Other Payment
3. Reporting Thresholds
a. No Fault ORM and TPOC
b. Liability Insurance ORM
c. Workers’ Compensation ORM
d. Workers’ Compensation
and Liability Insurance
Interim TPOC Thresholds
C. Frequency
D. What it Means
VIII. Conditional Payments
A. Defined
B. The Reach of CMS
C. Recovery Process
D. Time Limits to Seek Recovery
E. Impact
F. Compromise
IX. Taking Medicare’s Future Interests into Account
A. Workers’ Compensation
1. The Origin of the Medicare Set-Aside
2. The CMS Memorandums
3. Thresholds
B. Liability Insurers
1. Applicability
2. Mass Torts
C. Negotiation Process
1. Timeline for Negotiation
2. Common Settlement Language
a. Common Provisions and their
Purposes
b. Common Settlement Scenarios
X. The Medicare Set-Aside
A. Defined
B. The Basic Medicare Set-Aside
1. Gathering Information
2. Analyze the Medical Records
3. Project Future Medical Needs
4. Determine Medicare Status
5. Incorporating the Coding and Pricing
6. Using a Rated Age
7. Assembling the Report
8. Submission
9. Should a Single Individual Prepare the
Medicare Set-Aside?
XI. Allocation Issues
A. The $0 Set-Aside
1. Legal Zero
2. Medical Zero
B. Part D Issues
1. Inclusion
2. Average Wholesale Price
3. Donut Hole
C. Non-Medicare Covered Items
XII. Submission
A. Workers’ Compensation
B. Liability Cases
1. Applying the MSP in the Individual Case
2. Analyzing the Case for Purposes of
Submission
C. Due Process Concerns
XIII. Funding Issues
A. Annuities / Structures
B. Seed Money
C. Separation of Funding
XIV. Administration
A. Considerations
1. Professional v. Self
2. Costs of Administration
B. Duties
C. Common Issues that Arise
1. Amount of Reimbursement Rates
2. Medicare Covered Items and Services
3. Services Received While Traveling
4. Taxes
5. Use of Funds Prior to Medicare
Entitlement
6. Loss of Medicare Entitlement
after Establishment of an MSA
7. Death of the Claimant
D. Exhausting the Account
1. Temporary Depletion
2. Permanent Depletion
XV. Forms of Medicare Set-Aside Arrangements
A. The Generic MSA
B. The MSAT
C. Special Needs Trusts
XVI. Special Issues
A. Eligibility
XVII. The MSP Compliance Market
XVIII. Conclusion
MSA PRACTICUM ASSIGNMENT / DISCUSSION
POLICY REGARDING SUBSTITUTION / CANCELLATION: You may substitute another person at any time. We will refund tuition, less a $50 cancellation charge if we receive cancellation ten (10) business days prior to the seminar date not including the actual seminar date. No other refunds will be given.
