2023 Knowledge Series

During these complimentary sessions, you’ll hear from our experienced team on a variety of forward-looking Medicare Secondary Payer (MSP) related topics with a focus on offering insights that help you stay informed and stay ahead – of both compliance requirements and your competition.

Completed Webinars
Please email us for the password needed to access each recorded session.

December 5

 

Section 111 Reporting: Expansion of TPOC Reporting to include MSA Data
The Centers for Medicare & Medicaid Services recently held a webinar to discuss an upcoming expansion of Section 111 TPOC reporting to include submitted and non-submitted Workers’ Compensation Medicare Set-Aside (WCMSA) information. Join our team to learn more as they share highlights from the webinar and take a deeper dive into this change and how it may impact your organization. We will explore:

    • How this applies to all Workers’ Compensation MSAs, regardless of whether the MSA was submitted to CMS for review
    • What types of data will be collected
    • When CMS estimates the expansion will be implemented and dates for related milestones
October 12

 

Civil Money Penalties: Examining the Final Rule
Yesterday, the Centers for Medicare & Medicaid Services issued an alert that it finalized the rule specifying how and when it will calculate and impose Civil Money Penalties. Join us tomorrow to learn more as our team takes a deep dive into CMPs, with a particular focus on the final rule. We will explore:

    • How the final rule evolved from the version proposed in 2020 and what stuck in the final rule (and what didn’t make the cut).
    • What key points you need to know, and what steps need to be taken in the short and long term to limit your risk of CMPs.
    • How RREs can prepare now and shore up their compliance before CMS begins issuing penalties for non-compliance in October 2024.
August 23

 

The (Mixed) Reviews Are In: Simplifying Mandatory Insurer Reporting
Section 111 Mandatory Insurer Reporting is on everyone’s mind these days. New Non-Group Health Plan User Guides seem to be coming out more frequently, Civil Monetary Penalties are anticipated in 2024 and what is an “Unsolicited Response File” anyway? Join us as we explore all things Section 111. Key takeaways:

    • Discuss the information provided by CMS regarding Unsolicited Response Files during their townhall meeting on June 6 and explore any potential impacts on claim handling and settlement.
    • Examine changes to version 7.2 of the NGHP User Guide (released in June) and get a refresher on all Section 111 activities since the extension of the deadline for a ruling on Civil Monetary Penalties.
August 9

 

That’s a Wrap: Finalizing the Settlement
Just getting to settlement on cases involving Medicare considerations can be challenging enough, but that is only one piece of the puzzle. Join us as we discuss the elements of finalizing the settlement including completing the CMS submission process, finishing documentation, securing funding, and providing administration. Key takeaways:

    • Identify the Medicare Secondary Payer compliance items to be resolved at settlement and discuss when and how to utilize each option.
    • Discover how “post settlement” discussions and processes (like CMS submission, funding, and administration) can hold up final resolution of a case.
    • Discuss processes for CMS submission, funding, and administration, identify potential pain points, and review potential solutions.
July 26

 

Plot Twist: Considering Medicare’s Interests in Liability Settlements
Who Saw That Coming? While Medicare Secondary Payer for Workers’ Compensation has some structure to it (i.e., WCMSA Reference Guide), parties often find it more challenging to consider Medicare’s interests in liability settlements. This webinar will provide an overview of the various aspects of Medicare Secondary Payer (MSP) compliance as related to liability cases. We will also discuss Section 111 Mandatory Insurer Reporting and Conditional Payments for liability cases and how they may require more cooperation between the settling parties. Will we walk through Reporting and Lien Resolution on liability cases and review the importance of the settling parties’ agreement on the MSP pieces of the settlement. Key takeaways:

    • Explore how considering Medicare’s interest in liability settlements differs from workers’ compensation cases and how that may broaden your options for resolution.
    • Discuss possible options for resolution.
    • Gain a better understanding of the importance of achieving agreement on the MSP related components of the settlement.
June 14

 

It Starts with a Script: Building a Cost-Effective Allocation
While the story continues to evolve, it is critical for you to stay informed to remain compliant and minimize risk in the rapidly changing Medicare Secondary payer compliance landscape. Join us as we explore the importance of pre-allocation mitigation, settlement consulting services, MSA options, understanding CMS trends and more. Key takeaways:

  • Review your pre- and post-allocation mitigation options for the lowest defensible allocation.
  • Assess settlement tools and resources that can help you bring your claim to a close.
June 28

 

Finding the Right Talent: Establishing Medicare & Social Security Status
Determining whether a Medicare Set-Aside is appropriate is often linked to a claimant’s entitlement status. This webinar will explore the pathways to obtaining Social Security Disability and how that status relates to Medicare entitlement. We will also discuss the importance of evaluating CMS workload review thresholds and discuss the basics of Part A, Part B, Part C, and Part D. Key takeaways:

    • Learn basic information about Social Security Disability and Medicare entitlement and the impact a beneficiary’s status can have on determining whether to request a Medicare Set-Aside.
    • Examine the thresholds for CMS review and discuss why being above the threshold does not equate to “needing” a Medicare Set Aside.
July 12

 

Lights, Camera, Action: Exploring Conditional Payment Litigation
Join us as we review cases related to Conditional Payments with a particular focus on recent litigation involving LifeWallet (formerly MSP Recovery). We will discuss the elements of each case including arguments made to the Court, the court’s decision, and any impact those decisions may have on your Conditional Payment program. Key takeaways:

    • Gain a better understanding of the current status of conditional payment litigation.
    • Learn what you can do to prevent these types of claims and recovery actions
April 19 Is CMS Still Approving Zero Waiver MSAs?
In this webinar, we will explore considerations for Zero Waiver MSAs including examining the language and documentation required by CMS, discussing clean cases where no loss payments were made, and assessing the best methods for disputing Zero Waiver MSAs. Key takeaways:

  • Understand when and how MSA Waivers can be submitted to CMS
  • Determine when to use a Non-Submit Zero MSA to help with settlements on denied claims that are not reviewable by CMS
  • Review the steps needed to secure an elusive Zero Waiver MSA with CMS
April 5 Is It True That Non-Submit MSAs Can No Longer Be Used?
In January of 2022, CMS released a new version of the WCMSA Reference Guide (version 3.5), adding section 4.3 The Use of Non-CMS-Approved Products to Address Future Medical Care. Some in the industry interpreted section 4.3 to mean you could no longer opt out of the CMS submission process. However, that is not the case. CMS followed with an updated version of the WCMSA Reference Guide, version 3.6, which confirmed that submission remains voluntary. We will walk through the facts and discuss where we stand on the age-old question – To Submit or Not Submit? Key takeaways:

  • Discuss existing statutes, regulations, and CMS guidance regarding submission of MSAs to CMS for review and determination
  • Explore the differences between submitted MSAs and non-submit options and discuss when Non-Submit MSAs can be an effective tool to close cases
March 22 Can I Do Anything About My Result from CMS or am I Stuck?
So, you submitted an MSA to CMS for review and received an unfavorable result, possibly impacting your settlement indefinitely. Are you stuck with their decision, or do you have options to pursue? Join us to explore the tools available for post-CMS review and how to set yourself up for success when requesting a Re-Review or Amended Review from CMS. Key takeaways:

  • Gain a better understanding of when a CMS approved MSA qualifies for a Re-Review, along with the limitations and benefits related to your request
  • Be able to identify CMS approved MSAs on file for unsettled claims that may qualify for Amended Review
  • Review methods for bringing your case closer to the MSA number needed to achieve settlement
March 8 Exploring Different Processes for Medicare Liens: Parts A, B, C, and D
For traditional Medicare (Parts A and B), a specific process is used for conditional payment search and collections through Section 111 reporting information. However, the process may differ if a Medicare Part C or Part D plan is involved. Since Medicare has updated its query response system to include information from Medicare Part C and D plans, carrier/self-insureds now have a great opportunity to identify and resolve Medicare Part C and D liens prior to recovery litigation. Key takeaways:

    • Explore the lien process for the different parts of Medicare
    • Discuss how carrier/self-insureds can use Medicare’s query response system to effectively identify, track, and resolve conditional payments for all parts of Medicare.
February 22 This Case Won’t be Able to Settle: How Can I Lower MSA Costs?
Future settlement values are too often overinflated due to unclear documentation, inclusion of unwanted treatment(s), inclusion of high-dollar medications, and a variety of other reasons. We will discuss CMS’ policies, review claim mitigation strategies, and explore how to achieve mutually agreeable resolutions for you and the opposing party. We will provide several examples of ways to lower future medical projections and/or reduce the risks associated with the CMS submission process. Key takeaways:

    • It is highly important to understand the CMS methodologies that lead to large counter opinions.
    • You can develop and execute strategies that result in increased certainty in the CMS review process.
    • Being able to mitigate future medical pricing, even if not submitting an MSA to CMS, benefits both parties and facilitates settlement.
February 8 What Do I Need to Know About Section 111 Reporting?
Section 111 Reporting is a central part of Medicare Secondary Payer compliance. Mistakes in reporting ORM, ORM Termination, TPOC, ICD-Coding and other data can not only impact conditional lien exposure, but also may soon subject you, or your customers, to Civil Monetary Penalties. Key takeaways:

    • Gain an understanding of what is necessary for proper Section 111 Reporting
    • Explore things you can do now to help prevent inflated conditional liens and potential penalties in the future

Your Presenters

   

Bridget Smith
Sr. VP, National Accounts
and Settlement Consulting

Jennifer Shymanski  

Jennifer Shymanski
Vice President,
Implementation and Strategy

 

Jennifer Mislanovich
Director,
Legal & Compliance

 

Mark Heberling
Vice President,
Settlement Consulting

 

Patrick Czuprynski
Director,
Lien Resolution

 

Dawn Dietz
Assistant VP,
Settlement Consulting

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