Medicare, Medicaid, and SCHIP Extension Act: What All Lawyers and Their Clients Must Know About the Act Before Settling a Personal Injury Claim
|
|
- Annabella Booker
- 8 years ago
- Views:
Transcription
1 Medicare, Medicaid, and SCHIP Extension Act: What All Lawyers and Their Clients Must Know About the Act Before Settling a Personal Injury Claim SPEAKERS: W. Randall Bassett Stephanie Ann Webster Tara Kay Kelly Tuesday, November 17, :00 1:00 p.m. Eastern Time
2 Costs and Benefits of MMSEA 400 hours: estimated minimum cost of designing, building, and operating a system to comply with MMSEA does not include ongoing costs $200 million: estimated amount Medicare expects to shift back to primary plans as expanded to include self-insured entities $89 trillion: estimated amount of Medicare s unfunded liabilities 5X greater than Social Security s unfunded liability 2
3 Centers for Medicare and Medicaid Services ( CMS ) Agency within the U.S. Department of Health and Human Services Formerly known as the Health Care Financing Administration Currently administers Medicare, Medicaid, and the Children s Health Insurance Program (CHIP) 3
4 Scope of Medicare Eligibility 65 years or older Disabled End-stage renal disease Coverage (in 2008) 45.2 million beneficiaries $462 billion in benefits and $468 billion in total expenditures 4
5 Medicare Identifiers HICN number used by Medicare to identify Medicare beneficiaries and track payments SSN plus identifier SSN and HICN used for a variety of data matches for Medicare payment purposes 5
6 Medicare Payment Medicare generally pays healthcare providers, not Medicare beneficiaries If a provider chooses to bill Medicare when another payer could have responsibility for payment, the provider loses the right to pursue additional funds from the other payer 6
7 Medicare Legislation 7
8 Medicare Secondary Payer (MSP) Medicare secondary payer (MSP) provisions enacted in 1980s Medicare generally will not pay for treatment if any another entity has an obligation to pay The responsible entity is known as the primary plan Medicare authorized to recover payments from a primary plan even if the primary plan has already paid to settle the claim 8
9 The Medicare Prescription Drug Improvement, and Modernization Act of 2003 ( MMA( MMA ) Expanded the definition of primary plan to include selfinsured entities that bear their own risk This definition includes tort defendants who pay judgments and settlements out of their own pockets 9
10 The Medicaid, Medicare, and SCHIP Extension Act of 2007 (MMSEA) CMS no longer has a mere right to seek reimbursement Imposes an affirmative duty on entities including tort defendants to report the resolution of any claim or action brought by a beneficiary Provides stiff penalties for failure to report up to $1,000 a day per claimant 10
11 Implementation of MMSEA Section 111 CMS is responsible for implementing the very complicated provisions of the Medicare statute-- how? -Guidance issuances -Regulations adopted through notice and comment rulemaking 11
12 Implementation of MMSEA Section 111 Rules can change until adopted in regulations CMS is notorious for adopting retroactive clarifications of prior policy 12
13 Medicare Right to Reimbursement A tort defendant s responsibility is established through judgment, settlement, or other payment No admission of liability is required CMS may recover from beneficiaries and third parties who receive funds from primary plans If CMS is unable to recover from the recipients it may seek payment directly from the primary plan even if it has already paid to settle the claim 13
14 Complying With Reporting Requirements of MMSEA 14
15 1. Register with CMS Responsible Reporting Entity ( RRE ): any entity that is or may become liable to CMS as a primary plan September 30, 2009: RREs that expect to have something to report were required to begin registering Informal Guidance: CMS has stated informally that it will not penalize RREs for failing to register by September 30; if not already registered, then do so immediately 15
16 2. Determine Plaintiff s s Status What: RREs must determine the status of all plaintiffs with whom claims are settled on or after January 1, 2010 Who: RREs bear the sole responsibility for accurately determining a plaintiff s status How: RREs must implement a procedure to determine plaintiff s status When: RREs have ongoing duty to determine a plaintiff s status 16
17 3. Reporting Electronic: all reporting must be done electronically July 1, 2010: deadline for RREs to submit first reports for claims settled after January 1, 2010 Required Information: Plaintiff s name, DOB, SSN or HICN CMS may require up to 100 categories of information about the claim RREs must keep existing reports updated and correct 17
18 RRE Registration Registering RREs within a corporate structure A parent company may register as a RRE for a direct subsidiary whether or not the parent qualifies as an RRE A subsidiary company may not register as an RRE for its parent An entity may not register as an RRE for its sibling company 18
19 What Claims Are Reportable? 19
20 Exempt Reporting Amounts January 1, 2010 through December 31, 2011: $0 - $5,000 January 1, 2012 through December 31, 2012: $0 - $2,000 January 1, 2013 through December 31, 2013: $0 - $600 20
21 Excluded Claims Date of exposure before December 5, 1980 No exposure on or after December 5, 1980 alleged, established and/or released Specific to a claim/defendant Burden of documenting on RRE 21
22 When Are Claims Reported? 22
23 Timeframe to Report Claims TPOC Date: date agreement obligating RRE to pay a claim is signed unless court approval is required April-June, 2010: period for submitting initial reports of claims after testing Quarterly Reporting: within the 7 day file submission timeframe assigned to RRE 45 day Grace Period: if TPOC date occurs 45 days before file submission period then claim reported during the next quarter 23
24 Risks of Non-Compliance 24
25 Failure to Register and Report MMSEA authorizes fines for failure to register and report Up to $1,000 per day reporting is late for each plaintiff beneficiary Electronic registration and reporting procedures and requirements are complex Self Study Code
26 Recovery against RRE RRE may be forced to reimburse CMS even though it has already paid the plaintiff CMS may recover double damages if legal action is required to secure payment from the RRE The result is potential triple liability for the RRE 26
27 Best Practices for Complying with MMSEA 27
28 Initial Inquiry: Best Practices Consider a task group and point person(s) to coordinate MMSEA issues and answer questions Identify persons who will gather information, query CMS database, and report Determine and communicate assigned 7-day reporting period Conduct training and partner with client to understand their process and concerns Gather information on cases where MMSEA reporting is required Coordinate with co-defendants and industry trade groups 28
29 Best Practices During Litigation: Obtain discovery on Medicare status and pre-1980 exposure if applicable Query CMS database and document results and dates of queries Use CMS safe harbor documentation where claimant will not provide necessary information Monitor changes in MMSEA and update procedures regularly Engage CMS and offer written comments on proposed changes in the guidance Conduct periodic audits of recordkeeping, querying, and reporting functions to improve process and document your practices 29
30 Best Practices Settlement: Assess completeness of information needed for reporting when settlement discussions appear imminent Query CMS database upon notice of mediation or other event triggering potential settlement Structure settlement to require information needed for reporting Incorporate indemnity language and other provisions addressing MMSEA concerns into the settlement agreement Consider whether MSA ( Medical Set-Aside ) is needed where future medicals are likely Retain discovery and other documents that support decision NOT to report (e.g., discovery showing no pre-1980 exposure) 30
31 Best Practices Settlement (If Medicare Recipient): Obtain statement of conditional payments from plaintiff or Medicare at beginning of case and least 60 days before potential settlement Eliminate or minimize exposure to CMS for reimbursement for conditional payments write two settlement checks: one to CMS and one to plaintiff s counsel establish escrow account holding amount equal to conditional payment obtain letter of satisfaction and indemnity from plaintiff 31
32 Implications and Outstanding Questions 32
33 Effects on Settlement Strategy Adds another hurdle to settlement negotiations Increases transactional costs and could eliminate nuisance settlements with Medicare recipients Confidentiality is uncertain Complicates aggregate settlements and other settlement mechanisms where allocation is unknown to the defendant 33
34 CMS Mass Torts Working Group Purpose: Discuss issues unique to reporting settlement of mass tort and class action claims Discussions are preliminary and should not be used as guidance Issues: Timing of reporting recognition that information for reporting often is unknown at time of settlement considering alert to CMS that settlement is imminent report required only when name of claimant is known, allocation of settlement to claimant is known, and funding has occurred Scope of reporting less detailed reporting is being discussed 34
35 CMS Mass Torts Working Group Structuring settlements cannot throw money over the wall defendants can no longer enter into settlements where they do not know individual allocations to Medicare recipients Considering allowance for settlements in the pipeline Non-reporting of pre-1980 exposure claims considering language that would allow broad release where uncontroverted facts show no pre-1980 exposure burden will be on RRE to establish uncontroverted facts Updated User s Guide due shortly as well as updated language on RREs 35
36 Speaker Biography W. Randall Bassett (404) Randy Bassett is a partner with King & Spalding s Product Liability Practice where he has over 15 years experience representing foreign and domestic manufacturers in high exposure product liability cases. He has represented product manufacturers such as Brown-Forman Corporation, General Motors, Purdue Pharma, Reynolds American Inc., and Sofamor Danek in the federal and state courts throughout the Southeast and Southwest. He has argued cases in the federal circuit court of appeals for the Fourth, Sixth, and Eleventh Circuits, and has appeared in the appellate courts of Alabama, Florida, Georgia, North Carolina, and Tennessee. Mr. Bassett has been recognized by Chambers USA and Legal 500 for his work in the area of products liability. He is a graduate of The Citadel and the University of Georgia School of Law and is a member of the state bars of Georgia and Florida. 36
37 Stephanie Ann Webster (202) Speaker Biography Stephanie Webster is a partner in the Healthcare Practice Group at King & Spalding and practices in the areas of Medicare and Medicaid reimbursement. She has been elected to the firm s partnership effective January 1, She counsels hospitals regarding payment and compliance, and represents them in administrative and federal court litigation. Ms. Webster has significant experience with Medicare and Medicaid disproportionate share hospital (DSH) and graduate medical education (GME) payment matters. She formerly served as an attorney for the Office of General Counsel for the U.S. Department of Health and Human Services and has been recognized as an Outstanding Healthcare Litigator. Ms. Webster s other professional experience includes work at the Texas Legislative Counsel in areas including Medicaid, hospital districts, and insurance. Ms. Webster also worked as an attorney for Legal Aid of Central Texas. 37
38 Speaker Biography Tara Kelly (713) Tara Kelly is of counsel in the Houston office of King & Spalding and a member of its Litigation Practice Group. Ms. Kelly currently represents Chevron in environmental toxic tort litigation pending in Louisiana. She has also worked on a number of products liability cases, defending pharmaceutical, medical device, and tobacco companies. Ms. Kelly graduated, summa cum laude, and with program distinction from Stockton State College in New Jersey with a B.A. in philosophy in She graduated in 1996 from American University in Washington, D.C., with an M.A. in literature. She received her J.D., cum laude, from New York University School of Law in She is a member of the New Jersey State Bar Association and the State Bar of Texas. 38
39 Appendix A Glossary of Selected MMSEA Terms 39
40 Glossary Account Designee: assigned at discretion of RRE may be an agent can upload and download files cannot serve as Authorized Representative or Account Manager for another RRE Account Manager: required for each RRE may be an agent can be associated with another RRE ID may designate Account Designees Authorized Representative: required for each RRE must be in the RRE organization with legal authority to bind the company ultimate accountability for RRE compliance but no personal liability 40
41 Glossary HICN Medicare Health Insurance Claim Number ORM Ongoing Responsibility for Medicals refers to the RRE s responsibility to pay, on an ongoing basis, for the injured party s (the Medicare beneficiary s) medicals associated with a claim. This typically only applies to no-fault and workers compensation claims. RRE Registered Reporting Entity TPOC Total Payment Obligation to Claimant refers to the dollar amount of a settlement, judgment, award, or other payment in addition to/apart from ORM. A TPOC generally reflects a one-time or lump sum payment of a settlement, judgment, award, or other payment intended to resolve/partially resolve a claim. TPOC date: Date payment obligation was established. This is the date the obligation is signed if there is a written agreement unless court approval is required. If court approval is required it is the later of the date the obligation is signed or the date of court approval. If there is no written agreement it is the date the payment (or first payment if there will be multiple payments) is issued. See p. 136, Field 100, User s Guide Version
42 Appendix B Checklist for Creating MMSEA Guidelines 42
43 A Checklist for Creating Internal Guidelines Initial Inquiry: Does the client have a set of procedures for MMSEA compliance? What training should be provided? Who should handle the initial identification of cases implicated by the MMSEA? What initial information should be gathered about the cases and claimants? What discovery requests should be served to identify and verify Medicare status and when? What procedures and forms should be used to collect and transmit information to query the CMS database? What steps are being taken to maintain confidentiality over claimants data? 43
44 A Checklist for Creating Internal Guidelines During Litigation: Who will be the contact person for MMSEA issues? When should the CMS database initially be queried? How often should the CMS database be queried? How much discretion should counsel have in querying the CMS database? Should reporting information be obtained on claimants who are not Medicare recipients? How often should outside counsel seek supplemental discovery on Medicare status? How should updates/changes to the law be communicated? 44
45 A Checklist for Creating Internal Guidelines Settlement: What information should be reported internally and when? How many days before a settlement should the CMS database be queried again? Who should do the reporting to CMS and how should this information be entered and reviewed to achieve maximum accuracy? What form should be used in preparing settlement documents for a claim involving a Medicare recipient? What preferred method should be used for structuring the settlement to ensure CMS is reimbursed? Should a set-aside be created for future medicals? What documents should be retained in the event of an audit? 45
46 Appendix C CMS Resources 46
47 CMS Resources General link to CMS website regarding MMSEA: Statutory Language: orylanguage.pdf Link to MMSEA User s Guide 2.0 for Liability Insurance: PUserGuide2ndRev pdf CMS Town Hall Transcripts on MMSEA: ripts.asp#topofpage 47
48 CMS Resources CMS comment mailbox on MMSEA issues: Model language for discovery purposes: ads/nghhicnssnnghpform.pdf 48
Understanding the Medicare, Medicaid and SCHIP Extension Act of 2007
Understanding the Medicare, Medicaid and SCHIP Extension Act of 2007 CNA believes we are more than your underwriting and risk management provider. Our ongoing customer service, technical support, and consultative
More informationQuick Reference Guide Version 1 January 19, 2012
Centers for Medicare & Medicaid Services (CMS) MMSEA Section 111 Mandatory Insurer Reporting Quick Reference Guide Version 1 January 19, 2012 For Non-Group Health Plan (NGHP) Insurers The What, Why and
More informationMedicare Indemnity and Defense by Federal Mandate?
Medicare Indemnity and Defense by Federal Mandate? Christian R. Johnson Ebanks Horne Rota Moos LLP 1301 McKinney, Suite 2700 Houston, TX 77010 (713) 333-4500 (713) 333-4600 [fax] cjohnson@ethlaw.com www.ethlaw.com
More information1, 2011, and will apply to payment obligations assumed on or after October 1, 2010. See
Medicare Reporting and Reimbursement Compliance Issues in Mass Products Liability Cases in which Exposure on or after December 5, 1980, is Generally Alleged, Established, and/or Released. By: Lynn O. Frye,
More informationMEDICARE AND LIABILITY CASES. A. The Medicare Secondary Payer Statute
MEDICARE AND LIABILITY CASES I. The Significant Statutory and Code Provisions A. The Medicare Secondary Payer Statute The Medicare Secondary Payer statute (MSP) has been the law for well over 25 years.
More informationThe Reporting Requirement You May Not Know About that Could Cost Your
The Reporting Requirement You May Not Know About that Could Cost Your Company $1,000 per Day The Mechanics and Litigation Repercussions of MMSEA 111 Jennifer A. Creedon jcreedon@verrilldana.com (617) 309-2618
More informationIn 2007, Congress passed Section 111 to the Medicare, Medicaid
SCHOLARLY ARTICLE What Every Attorney Must Know About Medicare Reporting and Reimbursement By Toni J. Ellington In 2007, Congress passed Section 111 to the Medicare, Medicaid and SCHIP Extension Act (MMSEA).
More informationWelcome to the Reportable Claims course.
Welcome to the Reportable Claims course. Note: This module applies to Responsible Reporting Entities (RREs) that will be submitting Section 111 claim information via an electronic file submission as well
More informationMandatory Reporting Thresholds Friday, October 09, 2015
Slide 1 - of 26 Welcome to the Mandatory Reporting Thresholds course. Note: This module applies to Responsible Reporting Entities (RREs) that will be submitting Section 111 claim information via an electronic
More informationLIEN ON ME. A Guide to Complying with Medicare s Secondary Payor Act and Pennsylvania s Act 44. April, 2009
LIEN ON ME A Guide to Complying with Medicare s Secondary Payor Act and Pennsylvania s Act 44 April, 2009 HARRISBURG OFFICE P.O. Box 932 Harrisburg, PA 17106-0932 717-975-8114 PITTSBURGH OFFICE 525 William
More informationBest Practices for Complying with New Medicare Reporting Requirements What Every Attorney Needs to Know By Ervin A. Gonzalez, Esq.
Best Practices for Complying with New Medicare Reporting Requirements What Every Attorney Needs to Know By Ervin A. Gonzalez, Esq. I. Overview: How does the MMSEA impact personal injury and mass tort settlements?
More informationISSUES ARISING OUT OF THE MEDICARE SECONDARY PAYER ACT
ISSUES ARISING OUT OF THE MEDICARE SECONDARY PAYER ACT BY EUGENE J. PODESTA, JR. BAKER, DONELSON, BEARMAN, CALDWELL & BERKOWITZ 165 Madison Avenue, Suite 2000 Memphis, TN 38103 Rising medical costs and
More informationMEDICARE REPORTING AND RECOVERY UPDATE
CLIENT UPDATE JULY 2012 MEDICARE REPORTING AND RECOVERY UPDATE MMSEA SECTION 111 REPORTING RRES NOT LIMITED TO QUARTERLY REPORTING Responsible Reporting Entities (RREs) were previously required to submit
More informationCLM 2016 Atlanta Conference May 19-20, 2016 in Atlanta, GA
CLM 2016 Atlanta Conference May 19-20, 2016 in Atlanta, GA Medicare Secondary Payer Compliance: The Critical Transition to the Commercial Repayment Center (CRC) What is Medicare? Medicare is an entitlement
More informationMANDATORY INSURER REPORTING: A PRIMER FOR RESPONSIBLE REPORTING ENTITIES
MANDATORY INSURER REPORTING: A PRIMER FOR RESPONSIBLE REPORTING ENTITIES INTRODUCTION Liability insurers, self-insured entities, and third party administrators should be aware of how Medicare s right to
More informationWelcome to the Total Payment Obligation to Claimant (TPOC) course.
Welcome to the Total Payment Obligation to Claimant (TPOC) course. Note: This module applies to Responsible Reporting Entities (RREs) that will be submitting Section 111 claim information via an electronic
More informationSubrogation and Liens: Basic Principles and Practical Considerations. Brandon E. Berg Thompson, Coe, Cousins & Irons, L.L.P.
Subrogation and Liens: Basic Principles and Practical Considerations Brandon E. Berg Thompson, Coe, Cousins & Irons, L.L.P. Houston, Texas Texas Hospital Lien Statute Texas Property Code gives a hospital
More informationmade by private organizations (called primary payers or primary plans). 4 This includes liability
passage of the Medicare Secondary Payer Act ( MSP ) 2 in 1980 provided for a redistribution of the primary payment burden. 3 Today, Medicare is a secondary payer to other available payment sources for
More informationMaryland Workers Compensation Commission Introduction
Maryland Workers Compensation Commission Introduction Medicare Secondary Payer Act & Workers Compensation Settlement Process What this is not... This presentation is not a tutorial on how to create and
More informationNew M&A insurance risk for buyers Medicare-related settlement clawback
January 2011 A publication from the Transaction Services practice New M&A insurance risk for buyers Medicare-related settlement clawback At a glance Companies across a wide range of industries must consider
More informationSUBROGATION AND MSAs. Settlement of W/C Claim As Part of Third Party Settlement Commutation/Dollar Contracts, Etc.
MEDICARE SET-ASIDES AND THE SUBROGATION PROFESSIONAL Presented By: Gary L. Wickert, Matthiesen, Wickert & Lehrer, S.C. Russell S. Whittle, Gould & Lamb, LLC GOTOWEBINAR ATTENDEE INTERFACE 1. Viewer Window
More informationWelcome to the Medicare Secondary Payer (MSP) Overview course.
Welcome to the Medicare Secondary Payer (MSP) Overview course. 1 While all information in this document is believed to be correct at the time of writing, this Computer Based Training (CBT) is for educational
More informationSolutions to New Medicare Compliance Rules: A Presentation to the National Council of Self-Insurers. National Coverage
Solutions to New Medicare Compliance Rules: A Presentation to the National Council of Self-Insurers National Coverage Medicare Crisis Medicare is now paying out more than it takes in. Healthcare costs
More informationwww.cms.hhs.gov/mandatoryinsrep/01_overview.asp INTRODUCTION October 1, 2010.
1. INTRODUCTION Recent changes in federal law represent a sea change in the consideration that must be given by defendants to the interests of Medicare. Up until March, 2009, Medicare, when attempting
More informationNew Medicare Reporting Requirements for Entities Paying Settlements or Judgments To Personal Injury Plaintiffs Who Are Medicare Beneficiaries
New Medicare Reporting Requirements for Entities Paying Settlements or Judgments To Personal Injury Plaintiffs Who Are Medicare Beneficiaries By Pamela W. Montgomery, R.N., J.D., LL.M. candidate (Health
More informationPolicy and Procedures for Recoupment & Coordination of Benefits: Workers Compensation Payment
Policy and Procedures for Recoupment & Coordination of Benefits: Workers Compensation Payment Effective Date: September 1, 2013 Effective Date for Section 32 Agreements: October 1, 2013 Revised: December
More informationMedicare Issues in Workers Compensation Settlements PRESENTED BY: MICHELLE A. ALLAN, ESQ.
Medicare Issues in Workers Compensation Settlements PRESENTED BY: MICHELLE A. ALLAN, ESQ. Medicare Basics Medicare is a health insurance program provided by the federal government for: People 65 years
More informationErrors and Omissions Liability Insurance for Medicare Statutory Compliance
The Problem and the Solution Medicare/Medicaid and SCHIP Extension Act of 2007 Errors and Omissions Liability Insurance for Medicare Statutory Compliance INSURANCE GROUP In 1980, in an effort to help curb
More informationGlossary of Terms and Acronyms
Glossary of Terms and Acronyms COB/COBC Coordination of Benefits - The Coordination of Benefits Contractor consolidates the activities that support the collection, management, and reporting of other insurance
More informationNEGOTIATING WITH MEDICARE AND MEDICAID
NEGOTIATING WITH MEDICARE AND MEDICAID I. MEDICARE PROVIDES HEALTHCARE COVERAGE A. Persons 65 Years Old and Older B. Certain Disabled Persons under 65 C. Persons with End-Stage Renal Disease II. MEDICARE
More informationThe Medicare Tsunami. Bigger than Medicare Set Asides. Stronger than the Medicare Secondary Payer Act. Faster than the end of the recession
The Medicare Tsunami Bigger than Medicare Set Asides Stronger than the Medicare Secondary Payer Act Faster than the end of the recession A Tsunami you can plan for 1 2 Outline Medicare Eligibility MSA
More informationSPECIAL NEEDS TRUST NEWSLETTER
SPECIAL NEEDS TRUST NEWSLETTER SEPTEMBER 2009 A. KEL LONG, III P.C. 3060 Peachtree Rd., Suite 1725 Atlanta, GA 30305 404 238 0174 AKL3PC@mindspring.com www.akellong.com For this edition of the newsletter,
More informationHOOPS 2008. MSP Update: New Programs, Added Burdens, Possible Expanded Opportunities Focus on CMS Implementation of Mandatory Insurance Reporting
HOOPS 2008 MSP Update: New Programs, Added Burdens, Possible Expanded Opportunities Focus on CMS Implementation of Mandatory Insurance Reporting Robert L. Roth Crowell & Moring, LLP 1001 Pennsylvania Avenue,
More informationPolicy and Procedures for Recoupment & Coordination of Benefits: Workers Compensation Payment
Policy and Procedures for Recoupment & Coordination of Benefits: Workers Compensation Payment Effective Date: September 1, 2013 I. Authority A. The James Zadroga 9/11 Health and Compensation Act of 2010
More informationHow To Deal With A Workers Compensation Claim In Gorgonia
Set-Aside Arrangements A Combined Effort by Overview: When is Medicare an issue? What is required when Medicare is an issue? Dealing with CMS and Medicare. Problems associated with Medicare in the context
More informationImpediments to Settlement
Impediments to Settlement W. Bruce Barrickman, Esq. 5775 Glenridge Drive Suite E100 Atlanta, GA 30328 678-222-0248 www.bayadr.com IMPEDIMENTS TO SETTLEMENT W. Bruce Barrickman, Esq. Mediation is a great
More informationMedicare in Personal Injury Claims: Understanding the Fundamentals
Presenting a live 90-minute webinar with interactive Q&A Medicare in Personal Injury Claims: Understanding the Fundamentals Complying with Reporting Requirements and Satisfying Medicare Liens When Settling
More informationINSTRUCTION LETTER TRONOX TORT CLAIMS TRUST INSTRUCTION LETTER (CATEGORY A) Dear Prospective Claimant or Claimant Counsel,
INSTRUCTION LETTER Dear Prospective Claimant or Claimant Counsel, The Tronox Incorporated Tort Claims Trust (the Trust ) has been established under Chapter 11 of the Bankruptcy Code to resolve all Tort
More information8/17/2012. Workers Compensation Institute. Learning Objectives. Agenda. 2012 Educational Conference
Workers Compensation Institute 2012 Educational Conference Seeing the Forest through the Trees: MSA/LMSA Trends Celia Mendez, Esq. Cynthia Sage, Esq. Rafael Gonzalez Moreland & Mendez FCCI Insurance Gould
More informationWHAT YOU NEED TO KNOW ABOUT MEDICARE LIENS, CONDITIONAL PAYMENTS, AND SET ASIDE TRUSTS
WHAT YOU NEED TO KNOW ABOUT MEDICARE LIENS, CONDITIONAL PAYMENTS, AND SET ASIDE TRUSTS Presented and Prepared by: Bradford J. Peterson bpeterson@heylroyster.com Urbana, Illinois 217.344.0060 The cases
More informationMMSEA Section 111 MSP Mandatory Reporting
MMSEA Section 111 MSP Mandatory Reporting Interim Record Layout Information for: Liability Insurance (Including Self-Insurance) No-Fault Insurance Workers Compensation The complete Section 111 User Guide
More informationSTATE OF MICHIGAN IN THE CIRCUIT COURT FOR THE COUNTY OF WAYNE CASE MANAGEMENT ORDER #17
Plaintiff understands that the Medicare Secondary Payer Act (42 U.S.C. 1395y(b))("Act") applies to any personal injury settlement involving a Medicare beneficiary and requires that Medicare be reimbursed
More informationStructured settlements currently play an important role in compliance with Medicare s Secondary Payer Act.
August 14, 2012 Centers for Medicare & Medicaid Services Department of Health and Human Services ATTN: CMS-6047-ANPRM Room 445-G Hubert H. Humphrey Building 200 Independence Ave., SW Washington, DC 20201
More informationMedicare in Personal Injury Claim Settlements: Complying with Reporting Requirements and Satisfying Liens
Presenting a 90-Minute Encore Presentation of the Teleconference with Live, Interactive Q&A Medicare in Personal Injury Claim Settlements: Complying with Reporting Requirements and Satisfying Liens TUESDAY,
More informationLiens: Workers' Compensation, Medicare, Medicaid, ERISA & DPW
Liens: Workers' Compensation, Medicare, Medicaid, ERISA & DPW Presented by: Daniel J. Siegel, Esquire Law Offices of Daniel J. Siegel, LLC Integrated Technology Services, LLC 66 West Eagle Road Suite 1
More informationUSING MEDICARE SET-ASIDE ARRANGEMENTS IN THIRD PARTY LIABILITY CASES By: Thomas D. Begley, Jr.
USING MEDICARE SET-ASIDE ARRANGEMENTS IN THIRD PARTY LIABILITY CASES By: Thomas D. Begley, Jr. This Special Report is brought to you by Begley Law Group. begleylawgroup.com This newsletter is not intended
More informationSPECIAL TOPICS IN GUARDIANSHIP COMPROMISING CLAIMS FOR MINORS AND INCAPACITATED ADULTS. November 8, 2013
SPECIAL TOPICS IN GUARDIANSHIP COMPROMISING CLAIMS FOR MINORS AND INCAPACITATED ADULTS November 8, 2013 Stephanie F. Brown McMickle, Kurey & Branch 200 South Main Street Alpharetta, GA 30009 (678) 824-7800
More informationLiability Set Asides Why There is a Need for Codification
Liability Set Asides Why There is a Need for Codification Jason D. Lazarus, Esq. For many years personal injury cases have been resolved without consideration of Medicare s secondary payer status even
More informationMedicare, Workers Compensation, and Liability Insurance
CAS Study Note Medicare, Workers Compensation, and Liability Insurance By George M. Levine, FCAS, MAAA Patty Smolen, FCAS, MAAA Jim Klann, FCAS, MAAA October 2012 Medicare, Workers Compensation, and Liability
More informationLiability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers Compensation
MMSEA Section 111 Medicare Secondary Payer Mandatory Reporting Liability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers Compensation USER GUIDE Chapter III: POLICY GUIDANCE Rev.
More informationPrepared by Whitney L. Teel, Esq.
New Medicare Notice And Reporting Regulations: A Discussion On How To Settle Cases Without Exposing Clients To Penalties Under The Medicare Secondary Payer Act Prepared by Whitney L. Teel, Esq. I. Introduction
More informationCMS Registration and Account Setup
CMS Registration and Account Setup Overview The registration process requires RRE s to provide notification to the COBC of their intent to report data to comply with the requirements of Section 111 of
More informationH.R. 1283 CONGRESSIONAL BUDGET OFFICE COST ESTIMATE. Asbestos Compensation Act of 2000. July 13, 2000
CONGRESSIONAL BUDGET OFFICE COST ESTIMATE July 13, 2000 H.R. 1283 Asbestos Compensation Act of 2000 As ordered reported by the House Committee on the Judiciary on March 16, 2000 SUMMARY H.R. 1283 would
More informationStructured Settlements. February 10, 2014 Noah S. A. Schwartz, CSSC J. Douglas Merritt, CSSC Richard Montarbo (Legal) Jack Blyskal (Moderator)
Structured Settlements Application in Liability and Workers Compensation February 10, 2014 Noah S. A. Schwartz, CSSC J. Douglas Merritt, CSSC Richard Montarbo (Legal) Jack Blyskal (Moderator) Today Review
More informationSupreme Court of the United States
No. 11-1197 ================================================================ In The Supreme Court of the United States --------------------------------- --------------------------------- VERNON HADDEN,
More informationWhat Every Self-Insured Hospital and Liability Insurance Company Needs to Know before January 2012!
Page1 What Every Self-Insured Hospital and Liability Insurance Company Needs to Know before January 2012! Medicare Medicaid SCHIP Extension Act (MMSEA) Section 111 Reporting Requirements This White Paper
More informationA Conversation About Lawyer Ethics and MSP Compliance
Compliance Connection By Bruce A. Cranner and John V. Cattie, Jr. A Conversation About Lawyer Ethics and MSP Compliance Why parties and their counsel need to take certain steps or risk incurring penalties
More informationsettlement planning guide for plaintiffs
settlement planning guide for plaintiffs If you expect to receive a settlement as the result of a major injury or the death of a loved one, it is normal to feel overwhelmed. You may have questions about
More informationSelf-Administration Toolkit for Workers Compensation Medicare Set-Aside Arrangements (WCMSAs)
Self-Administration Toolkit for Workers Compensation Medicare Set-Aside Arrangements (WCMSAs) For WCMSAs Approved by the Centers for Medicare & Medicaid Services (CMS) Version 1.1 January 5, 2015 1 Table
More information1 Nicole Miklos, Note: Giving an inch, then taking a mile: How the government s unrestricted recovery of conditional
The Effect of Medicare Set-Asides on Settling Jones Act Personal Injury Cases Lawrence R. DeMarcay, III Partner, Fowler Rodriguez Valdes-Fauli (Published and Presented on December 29, 2011- Tulane University
More informationLiability Claims in the Medicare Secondary Payer Arena: Planning the Medicare Set-Aside
Liability Claims in the Medicare Secondary Payer Arena: Planning the Medicare Set-Aside Charles D. Joyner Christine E. Harper I. Introduction Debate continues as to how to handle liability claims when
More informationSpecial Challenges for the Toxic Torts Practitioner Steven J. Joffe and Maria A. Caruana
T o x i c T o r t s a n d E n v i r o n m e n ta l L a w Taming the MMSEA Beast By Mary Ellen Gambino, Special Challenges for the Toxic Torts Practitioner Steven J. Joffe and Maria A. Caruana The frustration
More informationMedicare Update: Information to Help with the Darkness of Medicare Compliance. Peter H. Wayne IV, Esq.
FOR PUBLICATION IN THE 2012 WINTER EDITION OF THE ARKANSAS TRIAL LAWYERS ASSOCIATION S DOCKET Medicare Update: Information to Help with the Darkness of Medicare Compliance Peter H. Wayne IV, Esq. No matter
More informationMEDICARE SET-ASIDE UPDATE
MEDICARE SET-ASIDE UPDATE I. Social Security Disability Benefits A. Social Security Disability Income (SSDI) B. Obtained via application to the Social Security Administration C. Informal Hearing process
More informationWorkers Compensation & Medicare Set-Asides"
Workers Compensation & Medicare Set-Asides" Presented by: Betty Gregware, CSSC Mutual of Omaha & Toni Warbington, CSSC EPS Settlements Group W/C vs. Tortfeasor Liability" No provision to bring suit against
More informationNo Medicare Payments for a Claimant's Work-Related Injury or Disease until the WCMSA has been Exhausted
No Medicare Payments for a Claimant's Work-Related Injury or Disease until the WCMSA has been Exhausted (Ref: 7/23/01 Memo) The purpose of a Workers' Compensation Medicare Set-aside Arrangement (WCMSA)
More informationMass Tort Administration. Managed technology for the global legal profession
Mass Tort Administration 2013 Managed technology for the global legal profession Epiq Systems is the leader in providing fully-integrated services and technology for mass tort administration. From initial
More informationMEDICARE AND MEDICAID AVOIDING POST-JUDGMENT AND POST-SETTLEMENT LITIGATION WORKERS COMPENSATION AND MEDICARE SET ASIDE ISSUES
MEDICARE AND MEDICAID AVOIDING POST-JUDGMENT AND POST-SETTLEMENT LITIGATION WORKERS COMPENSATION AND MEDICARE SET ASIDE ISSUES INTRODUCTION Over the last 10 years workers compensation practitioners have
More informationWorkers Compensation Update Special Edition: Medicare Secondary Payer
By Roy Franco, Mark Noonan, and Stephanie Sorensen Medicare Secondary Payer Update The Medicare Secondary Payer Act (MSPA) 1 is a game-changer for claims offices across the country. The additional reporting
More informationFixed Percentage Option
Fixed Percentage Option What Is the Fixed Percentage Option? In an effort to streamline the recovery process, the Centers for Medicare & Medicaid Services (CMS), directed the Benefits Coordination & Recovery
More information(202) 223-8904 holmesd@uwcstrategy.org. Catherine Stanton (516) 471-1748 cstanton@workerslaw.com
FOR IMMEDIATE RELEASE Contact: Douglas Holmes (202) 223-8904 holmesd@uwcstrategy.org Catherine Stanton (516) 471-1748 cstanton@workerslaw.com SUPPORT FOR LEGISLATION TO IMPROVE THE ADMINISTRATION OF MEDICARE
More informationSedgwick Risk Management Solutions
There is a lot of uncertainty in the medical malpractice world today. While overall claims volume has decreased in recent years, risk managers are reporting an upswing in both the frequency and severity
More informationLiability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers Compensation USER GUIDE
MMSEA Section 111 Medicare Secondary Payer Mandatory Reporting Liability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers Compensation USER GUIDE Chapter IV: TECHNICAL INFORMATION
More informationWelcome to the International Classification of Diseases, ninth revision (ICD-9) Requirements Frequently Asked Questions (FAQ) course.
Welcome to the International Classification of Diseases, ninth revision (ICD-9) Requirements Frequently Asked Questions (FAQ) course. 1 Disclaimer While all information in this document is believed to
More informationMedicare Secondary Payer (MSP) Liability Insurance, No-Fault Insurance & Workers Compensation Recovery Process
Medicare Secondary Payer (MSP) Liability Insurance, No-Fault Insurance & Workers Compensation Recovery Process Note: This presentation is intended for Medicare beneficiaries and their representatives.
More informationLien Law: Recognizing and Management in the Personal Injury Case
Lien Law: Recognizing and Management in the Personal Injury Case I. INTRODUCTION At first blush, a personal injury plaintiff's procurement of proceeds either through settlement or adjudication may seem
More informationMichigan Property & Casualty Guaranty Association P.O. Box 531266 Livonia, Michigan 48153-1266 Phone: (248) 482-0381
Michigan Property & Casualty Guaranty Association P.O. Box 531266 Livonia, Michigan 48153-1266 Phone: (248) 482-0381 Dear Claimant: The Michigan Property & Casualty Guaranty Association ("the MPCGA") is
More informationUnderstanding Workers Compensation Claims
Understanding Workers Compensation Claims DESIREE TOLBERT, SEDGWICK CLAIMS MANAGEMENT SERVICES ROB VAN EPPS, FCAS, MAAA, FINANCIAL RISK ANALYSTS RAFAEL GONZALEZ, GOULD & LAMB, LLC Understanding Worker's
More informationMedicare Secondary Payer Fact Sheet. for Provider, Physician, and Other Supplier Billing Staff
Secondary Payer Fact Sheet for Provider, Physician, and Other Supplier Billing Staff BacM kground aintaining the viability and integrity of the Trust Fund becomes critical as the Program matures and the
More informationOSHR Workers Compensation Settlement Reserve Funds Allocations Beginning July 1, 2016. Administration Process Pages 2-5
OSHR Workers Compensation Settlement Reserve Funds Allocations Beginning July 1, 2016 Administration Process Pages 2-5 Agency Application Form Page 6 Instructions for Completion of Agency Application Form
More informationAN ACT IN THE COUNCIL OF THE DISTRICT OF COLUMBIA
AN ACT IN THE COUNCIL OF THE DISTRICT OF COLUMBIA To amend the District of Columbia Procurement Practices Act of 1985 to make the District s false claims act consistent with federal law and thereby qualify
More informationPolicy and Procedures for Recoupment: Lump-Sum Workers Compensation Settlements
Policy and Procedures for Recoupment: Lump-Sum Workers Compensation Settlements Effective Date: October 1, 2013 Revised: January 4, 2015 I. Authority A. The James Zadroga 9/11 Health and Compensation Act
More informationTORT CLAIM FORM PACKET
TORT CLAIM FORM PACKET Please carefully read all of the information in this packet before completing and presenting your Tort Claim Form. Documents Contained in the Tort Claim Form Packet Instructions
More informationMedicare Set-Aside Self-Administration
Medicare Set-Aside Self-Administration Why are claimants failing miserably? Since the establishment of Medicare s Coordination of Benefits Contractor in 2001, the Workers Compensation industry has come
More informationMEDICARE REPORTING RESOLVING CONDITIONAL PAYMENTS AND TAKING MEDICARE S INTEREST INTO ACCOUNT FOR FUTURE PAYMENTS
FLORIDA DEFENSE LAWYER S ASSOCIATION MEDICARE WHITEPAPER MEDICARE REPORTING RESOLVING CONDITIONAL PAYMENTS AND TAKING MEDICARE S INTEREST INTO ACCOUNT FOR FUTURE PAYMENTS By: Daniel J. Santaniello, Director,
More informationTable of Contents. DOA ORM Claims: Workers Compensation State Risk Adjuster 5
Table of Contents Job Description Orm-C250... 2 Update Job Description... 3 Overview Of Workers Compensation Orm-C251... 4 Supervise Activities Of Adjusters Orm- C252... 5 Adjuster Activities... 5 Supervisor
More informationThis Notice applies to you if you have had a parking ticket issued at one of the MBTA s Honor Box Parking Lots.
NOTICE OF PROPOSED SETTLEMENT OF CLASS ACTION PROVIDING RELIEF TO THOSE WITH UNPAID PARKING TICKETS ISSUED AT ONE OR MORE OF THE MBTA S HONOR BOX PARKING LOTS This Notice applies to you if you have had
More informationRights & Obligations under the Nebraska Workers Compensation Law
Nebraska Workers Compensation Court Information Sheet: Rights & Obligations under the Nebraska Workers Compensation Law NEBRASKA WORKERS COMPENSATION COURT OFFICIAL SEAL What is workers compensation? Workers
More informationMEDICAL BENEFITS CLASS ACTION SETTLEMENT NOTICE OF INTENT TO SUE
MEDICAL BENEFITS CLASS ACTION SETTLEMENT NOTICE OF INTENT TO SUE Complete this form if you are a MEDICAL BENEFITS SETTLEMENT CLASS MEMBER seeking to exercise a BACK END LITIGATION OPTION. In addition to
More informationSubmitting Settlement Information Monday, July 13, 2015. Slide 1 - of 21
Slide 1 - of 21 Welcome to the Medicare Secondary Payer Recovery Portal (MSPRP) Submitting Settlement Information course. As a reminder, you may view the slide number you are on by clicking on the moving
More informationWelcome to the International Classification of Diseases, Ninth Revision (ICD-9) Diagnosis Code Requirements Part I course.
Welcome to the International Classification of Diseases, Ninth Revision (ICD-9) Diagnosis Code Requirements Part I course. Note: This module applies to Responsible Reporting Entities (RREs) that will be
More informationTITLE 85 EXEMPT LEGISLATIVE RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER
TITLE 85 EXEMPT LEGISLATIVE RULE WORKERS' COMPENSATION RULES OF THE WEST VIRGINIA INSURANCE COMMISSIONER SERIES 9 WORKERS COMPENSATION UNINSURED EMPLOYERS FUND Section 85-9-1. General. 85-9-2. Definitions.
More informationMEDICARE AND WORKERS= COMPENSATION CLAIMS WHO=S ON FIRST? Michael E. Rusin. January, 2002
MEDICARE AND WORKERS= COMPENSATION CLAIMS WHO=S ON FIRST? Michael E. Rusin January, 2002 Michael E. Rusin Rusin Maciorowski & Friedman, Ltd. 10 South Riverside Plaza, Suite 1530 Chicago, IL 60606 (312)
More informationPersonal Injuries Happen. Justice Is Sought. Special Needs Must Be Addressed. Special Needs Require Special Settlement Planning
Personal Injuries Happen. Justice Is Sought. Special Needs Must Be Addressed. Special Needs Require Special Settlement Planning Why Use the Special Needs Law Firm? In most personal injury cases, the path
More informationErrors and Omissions Insurance. 1.0 Introduction and Definition
Errors and Omissions Insurance 1.0 Introduction and Definition 1.1 Under the terms of this policy the word employee means any trustee of the Board of Education, any employee of the Hicksville Board of
More informationAppendix I: Select Federal Legislative. Proposals Addressing Compensation for Asbestos-Related Harms or Death
Appendix I: Select Legislative Appendix I: Select Federal Legislative is and Mesothelioma Benefits Act H.R. 6906, 93rd 1973). With respect to claims for benefits filed before December 31, 1974, would authorize
More informationLiability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers Compensation USER GUIDE
MMSEA Section 111 Medicare Secondary Payer Mandatory Reporting Liability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers Compensation USER GUIDE Chapter I: INTRODUCTION AND OVERVIEW
More informationWhat Trustees Should Know About Florida s New Attorneys Fee Statute. By David P. Hathaway and David J. Akins. Introduction
What Trustees Should Know About Florida s New Attorneys Fee Statute By David P. Hathaway and David J. Akins Introduction More and more lawsuits are filed in Florida alleging that the trustee of a trust
More informationTHE IMPACT OF HIPAA ON PERSONAL INJURY PRACTICE
THE IMPACT OF HIPAA ON PERSONAL INJURY PRACTICE JEFFREY B. McCLURE Andrews & Kurth L.L.P. Copyright 2003 by Jeffrey B. McClure; Andrews & Kurth State Bar of Texas 19 TH ANNUAL ADVANCED PERSONAL INJURY
More information