Conditional Payments and the Medicare Secondary Payer Act (On-Demand)

Course Description

With close to 65 million beneficiaries today, Medicare has become the second largest health insurance program in the United States. One of our every 5 Americans is insured by the Medicare system. Whether through Part A, B, C, or D, all components of Medicare are entitled to reimbursement should Medicare make a payment where a primary payer or applicable plan is responsible for the same. The Medicare Secondary Payer Act obligates parties resolving workers’ compensation, automobile, liability insurance (including self-insurance) and no-fault insurance claims to address Medicare conditional payment or face the consequences.

This program walks attendees through the Medicare conditional payment reimbursement process. This program will review Medicare conditional payments as applied to the workers’ compensation, automobile, liability insurance (including self-insurance) and no-fault insurance prospectives. It will also address Medicare conditional payments as they relate to traditional Medicare fee-for-service (Parts A & B), Medicare Advantage (Part C), and Medicare Prescription Drug Plans (Part D). Attendees will leave this session with a basic understanding of how to know when a Medicare conditional payment obligation might exist, where to look to seek information about outstanding Medicare conditional payments, and how to verify, resolve, and satisfy Medicare conditional payments.

Syllabus

1. Introduction to Medicare – the Statistics
2. What is a Conditional Payment?
3. How do Conditional Payments Differ in 3^rd Party Liability Cases Compared to Workers’ Comp Cases?
4. How do Conditional Payments Differ When a Case Involves a Medicare Advantage or Medicare Prescription Drug Plan?
5. What Happens if you Disagree with Medicare Conditional Payments?
6. How can you Ensure that Medicare is Reimbursed Properly?

Instructors

John V. Cattie, Jr., Esq.

Rafael Gonzalez, Esq.