Medicare Secondary Payer Act: What you need to know in 2019 (On-Demand)

$169.00

The Medicare Secondary Payer act (MSP) was enacted on December 5, 1980. Despite being federal law for over thirty-five years, many attorneys still struggle with ensuring their settlements fully comply with the statute’s three basic requirements: ensure Medicare remains secondary to settlement proceeds, reimbursement of Medicare’s conditional payment amount, and report the settlement via the Section 111 reporting requirement. Since 2009, the Centers for Medicare and Medicaid Services (CMS) has methodically stepped up its enforcement of the MSP statute in all liability settlements. The most recent changes to CMS enforcement came in Fall 2017 when CMS took steps to ensure Medicare does not make any accident-related medical payments post-settlement. Further enforcement measures are anticipated by September 2019.

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Event Details

Course Type

Course Instructor

Christine Hummel, Esq.

Original Date Of Course

General Credits

2

Course Description

The Medicare Secondary Payer act (MSP) was enacted on December 5, 1980. Despite being federal law for over thirty-five years, many attorneys still struggle with ensuring their settlements fully comply with the statute’s three basic requirements: ensure Medicare remains secondary to settlement proceeds, reimbursement of Medicare’s conditional payment amount, and report the settlement via the Section 111 reporting requirement. Since 2009, the Centers for Medicare and Medicaid Services (CMS) has methodically stepped up its enforcement of the MSP statute in all liability settlements. The most recent changes to CMS enforcement came in Fall 2017 when CMS took steps to ensure Medicare does not make any accident-related medical payments post-settlement. Further enforcement measures are anticipated by September 2019.

Principles

  • What is a Medicare Set Aside and when do you need one?
  • The impact of Aetna vs Guerrera on Medicare Part C lien searches

Two Notices of Proposed Rule Making anticipated by September 2019

Syllabus

Section 1: Overview of the Medicare Program and Medicare Secondary Payer Act

  •  What is Medicare
  •  Qualifying for Medicare
  •  Three basic statutory requirements of the Medicare Secondary Payer Act

Section 2: Section 111 Reporting

  •  Who reports?
  •  When do you report?
  •  What do your report?
  •  Penalty for failing to report: Notice of Proposed Rule Making

Section 3: Medicare’s Conditional Payment

  •  Traditional Medicare: Parts A and B
    – Difference between the Benefits Coordination Recovery Contractor and the Commercial Repayment Center
    – Compromise Requests
    – Waiver Requests
    – The Final CP Process
  •  Medicare Part C and D plans
    – Statutory authority for Part C and Part D plans to assert a lien
    – Key differences between Medicare A/B liens and Medicare C/D liens
    – Case law discussion: In re Avandia, Humana cases, and Aetna vs Guerrera
  • Pitfalls and traps when conducting the Medicare conditional payment search(es)
  • Practice Tips

Section 4: The Medicare Set Aside (future medical allocation)

  •  Statutory Authority for CMS’ position that your settlement is primary to Medicare
  •  Case Law Discussion including the Aranki case and the Duff case
  •  What medical treatment should be paid from settlement proceeds
  •  Strategies for reducing the Set Aside allocation
  •  October 2017 changes to the Common Working File
  •  November 2017 educational outreach by CMS to the Medical Community and its impact on your clients
  •  Notice of Proposal Rule Making anticipated by September 2019
  •  Practice Tips

Instructor

Christine Hummel, Esq.