Hope You Can Join Us at RISE Virtual Conditional Payment Forum July 27-28

Rafael Gonzalez, Esq.

We had planned on being in Washington DC for the 2020 RISE MSP Conditional Payment Forum. We had planned for two full days of everything you wanted to know about Medicare conditional payments. We had planned on bringing the very best and most knowledgeable speakers to present on every component of conditional payments resolution. We had planned to explore civil money penalties proposed rules, proposed and anticipated MSP regulations and legislation, US Treasury issues and US Justice concerns. We had planned on focusing on conditional payment from conception to completion, bringing our attendees a 9-part breakdown of what to look for in every step of the recovery resolution process.

Unfortunately, COVID-19 health and safety concerns did away with the possibility of having our conference in DC. However, as a result of great planning, leadership and vision from RISE, all of our remaining planned goals have remained intact. As you will see below, all of our speakers have committed to doing the program virtually. As a result, our attendees will enjoy hearing and watching for two days the most experienced, most knowledgeable, and most respected panel of professionals in the MSP industry. As a group and individually, they will once again offer all attendees their years of expertise and experience in dealing with all components of Medicare conditional payments resolution.

Most conferences offer an hour, maybe two, on Medicare conditional payments. RISE’s MSP Conditional Payment Forum is the only national conference offering two full days focusing all things conditional payments. This is the only conference where auto, liability, no-fault, and work comp employers, corporate defendants, insurers, and third party administrators can come to learn the details of the process, the depth of the system, the intricacies of the law, and the evolution of the ever changing policies, regulations, legislation, and case law affecting conditional payment recovery resolution.

Hope you can join us! To sign up, please visit https://events.risehealth.org/events/the-4th-annual-medicare-secondary-payer-conditional-payment-forum-h754-/registration-f72e44f46731497f9d2118c9a0d44e0d.aspx?fqp=true

Day 1 (Monday July 27, 2020)

8:50 am – 9:00 am Welcome Remarks

Rafael Gonzalez, Esq., President, Medicare & Medicaid Compliance

Heather Schwartz Sanderson, Esq., Chief Legal Officer, Franco Signor LLC

9:00 am – 9:45 am CMS Notice of Proposed Rules Part 1

A Historical Review of Mandatory Reporting Civil Money Penalties

• Review the legislative history of imposition of civil money penalties 
• Examine legislative provisions regarding mandatory reporting requirements
• Summarize the public comments received on the 2013 advanced notice proposed rulemaking and how they serve as the foundation for the 2020 proposed rules

Frank Fairchok, CEO and Owner, NGHP Solutions LLC

Suzanne Jordan, SCHIP Compliance Manager, Broadspire 

9:45 am – 10:00 am Session Transition

10:00 am – 10:45 am CMS Notice of Proposed Rules Part 2

An Analysis of the Mandatory Reporting Proposed Civil Money Penalty Regulations

• Evaluate civil money penalty bases and scope; assess its potential impact, especially as they relate to the conditional payment resolution process
• Analyze civil money penalties imposition and amounts that could be handed by CMS, especially in connection with the resolution of conditional payments
• Proven good faith effort to reduce or extinguish the possibility of receiving civil money penalties

LaVonya Chapman, RN, Esq., Associate General Counsel, Settlement Solutions, UnitedHealth/Optum Workers Compensation and Auto No-Fault 

Robert Finley, Esq., Partner, Hinshaw Law

10:45 am – 11:00 am Session Transition

11:00 am – 11:40 am Regulation and Legislation Update Part 1

Medicare Secondary Payer Conditional Payment Case Law Update

• Analyze which organizations and individuals the U.S Federal Government is suing for reimbursement of conditional payments 
• Identify which entities Medicare Advantage Plans and their assignees are suing for reimbursement of conditional payments 
• Review of the hottest cases relative to resolution of conditional payment and how the case law is evolving, providing attendees with trends and patterns that allow for best practices

Heather Hatch, Partner, The Chartwell Law Offices, LLP 

Rachel LaMontagne, Esq., Partner, Shutts & Bowen

11:40 am – 11:55 am Session Transition

11:55 am – 12:40 pm Regulation and Legislation Update Part 2

Medicare Advantage and Part D Conditional Payment Best Practices

• Outline current available methodologies to determine a beneficiary’s Medicare Advantage and Part D enrollment status
• Identify key jurisdictions in which Medicare Advantage and Part D have the same double damages recovery rights as traditional Medicare
• Provide Best Practices for payors to implement to avoid lawsuits and claims from Medicare Advantage and Part D for double damages

Heather Schwartz Sanderson, Esq., Chief Legal Officer, Franco Signor LLC

12:40 pm – 1:10 pm Lunch

1:10 pm – 1:50 pm Conditional Payments Part 1

When Conditional Payments Go Wring: Dealing with the U.S. Department of Treasury

• Case Study: Dissect a recent account where the U.S. Department of Treasury offset an organization and another one in which a beneficiary’s monthly benefits were reduced
• An overview from lawyers representing applicable plans/payers and beneficiaries dealing with the U.S. Treasury that were offset unreimbursed past due amounts
• Strategies to avoid conflict with and offsets from the U.S Department of Treasury

Vanessa Lipsky, Partner/Section Lead Medicare Compliance Department, Eraclides Gelman Attorneys at Law

1:50 pm – 2:05 pm Session Transition

2:05 pm -2:45 pm Conditional Payments Part 2

When Conditional Payments Go Wrong: Dealing with the U.S. Department of Justice

• Hear what happens to lawyers and law firms representing Medicare beneficiaries who fail to reimburse conditional payments after the case settles
• Examine if the same thing could happen to employers, carriers, and third party administrators
• Identify when payers are responsible for reimbursement of conditional payment and how to avoid conflict with U.S. Department of Justice

Jason D. Lazarus, J.D., LL.M., MSCC, CSSC, Chief Executive Officer, Synergy Settlement Services

2:45 pm – 3:00 pm Session Transition

3:00 pm – 3:40 pm Conditional Payment from Conception to Completion Part 1

Verification of Claimant’s Medicare Beneficiary Status

• Obtain the correct documentation from the beneficiary to verify current Medicare status
• Validate with Medicare Advantage Plans and prescription drug plans to confirm status
• Utilize the mandatory reporting process to verify current Medicare beneficiary status

Michelle Allan, Partner, Gordon Rees Scully Mansukhani 

3:40 pm – 3:55 pm Session Transition

3:55 pm – 4:35 pm Conditional Payment from Conception to Completion Part 2

Verification of Data Submitted Through Mandatory Insurer Reporting

• Confirm date of accident/incident, ORM acceptance and termination dates, and TPOC date and amount are correctly reported 
• Verify the injuries related to the claim or that have been released/settled have been reported accurately 
• Certify ICD-10 codes that have been reported are accurate; and if they are not, what to do about it before you dispute or appeal CRC and BCRC’s request for reimbursement 

Frank Fairchok, CEO and Owner, NGHP Solutions LLC

Suzanne Jordan, SCHIP Compliance Manager, Broadspire

4:35 pm – 4:45 pm Chairperson Closing Remarks

Rafael Gonzalez, Esq., President, Medicare & Medicaid Compliance

Heather Schwartz Sanderson, Esq., Chief Legal Officer, Franco Signor LLC

Day 2 (Tuesday July 28, 2020)

8:50 am – 9:00 am Opening Remarks & Review of Day 1

Rafael Gonzalez, Esq., President, Medicare & Medicaid Compliance

Heather Schwartz Sanderson, Esq., Chief Legal Officer, Franco Signor LLC

9:00 am – 9:40 am Conditional Payment from Conception to Completion Part 3

Verification of Government’s Request Through the CMS Portals

• Confirm information on portal indicates all correct information on beneficiary and claim
• Affirm that portal amount matches the written request for reimbursement by CMS; and if not find and explain inconsistencies between the two
• Validate the correct amount owed as a basis for your request for disputes and further appeals, if necessary

Rose Arellano, Independent Consultant, Medicare Secondary Subject Matter Expert

LaVonya Chapman, RN, Esq., Associate General Counsel, Settlement Solutions, UnitedHealth/Optum Workers Compensation and Auto No-Fault 

9:40 am – 9:55 am Session Transition

9:55 am – 10:35 am Conditional Payment from Conception to Completion Part 4

Analyzing CMS’ Request for Reimbursement of Medicare Conditional Payments

• Analyze CMS request for reimbursement from the CRC to confirm payments are listed and claimed correctly
• Assess CMS request for reimbursement from the BCRC to verify payments are itemized and requested accurately 
• Determine which conditional payments are and are not related to the claim; identify discrepancies and formulate explanation and arguments for same

Monica Williams, Medicare Compliance Manager, Innovative Claims Strategies 

Rose Arellano, Independent Consultant, Medicare Secondary Subject Matter Expert

10:35 am – 10:50 am Session Transition

10:50 am – 11:30 am Conditional Payment from Conception to Completion Part 5

Disputing Medicare Conditional Payments

• An explanation and discussion of the process to dispute conditional payments with the CRC and the BCRC
• Identify which evidence you must, may, or can provide to the CRC and BCRC to support your arguments
• Evaluate which argument and strategies during dispute process generate the best success rates

Rose Arellano, Independent Consultant, Medicare Secondary Subject Matter Expert

John V. Cattie, Jr., Founding Member, Cattie, P.L.L.C.

11:30 am – 11:45 am Session Transition

11:45 am – 12:25 pm Conditional Payment from Conception to Completion Part 6

Requesting Redetermination of Medicare’s Demand for Reimbursement of Conditional Payments

• Strategies to improve consistency between arguments made throughout dispute process and mandatory reporting data submitted to CMS in light of proposed Civil Money Penalties 
• Analyze and critique actual Request for Determination that have previously been submitted to identify success, failure, missed opportunities, and inconsistencies
• Examine and further explore which strategies were successful, which arguments won or lost, and the feedback provided by the CRC and BCRC to identify best practices 

Rose Arellano, Independent Consultant, Medicare Secondary Subject Matter Expert

Robert Finley, Esq., Partner, Hinshaw Law

12:25 pm – 12:55 pm Lunch

12:55 pm – 1:35 pm Conditional Payment from Conception to Completion Part 7

Requesting Reconsideration of Medicare’s Demand for Reimbursement of Conditional Payments

• Avoid using the same arguments in reconsideration if they were unsuccessful in redetermination. Strategies to create new arguments using the same evidence
• Review an analysis of actual Request for Reconsiderations filed with the CRC and BCRB to examine success and failure and identify best practices 
• Identify patterns and trends from the various Qualified Independent Contractors deciding the Request for Reconsideration. Analyze what works and what doesn’t

Rose Arellano, Independent Consultant, Medicare Secondary Subject Matter Expert

Heather Hatch, Partner, The Chartwell Law Offices, LLP 

1:35 pm – 1:50 pm Session Transition

1:50 pm – 2:30 pm Conditional Payment from Conception to Completion Part 8

Preparing for and Succesfully Handling the Hearing Before the Administrative Law Judge

• Identify which evidence and exhibits will be critical to present to the ALJ to win your argument
• Introduce witnesses such as the adjuster, claimant, and doctor, to your case to increase validity of your argument and chances of winning
• Prepare all arguments based on facts of the case, limited to the items that you have appealed, relying on evidence submitted through Request for Reconsideration level

Rose Arellano, Independent Consultant, Medicare Secondary Subject Matter Expert

Michelle Allan, Partner, Gordon Rees Scully Mansukhani 

2:30 pm – 2:45 pm Session Transition

2:45 pm – 3:25 pm Conditional Payment from Conception to Completion Part 9

Post ALJ Hearing Request for Review by the Medicare Appeals Council and Beyond

• Review and analyze the ALJ decision to evaluate if it is the correct decision based on the evidence and law
• Identify errors in the ALJ decision with an eye towards requesting review by the Medicare Appeals Council- Examine what you should be looking for and best arguments to win or remand
• Prepare to request a review by U.S. District Court, if response from Medicare Appeals Counsel is deemed incorrect based on evidence and law
• Examine if requesting a review at the U.S. District Court is the best option and whether appealing at the Medicare Appeals Council is the best decision

Rose Arellano, Independent Consultant, Medicare Secondary Subject Matter Expert

Vanessa Lipsky, Partner/Section Lead Medicare Compliance Department, Eraclides Gelman Attorneys at Law

3:25 pm – 3:35 pm Closing Remarks

Rafael Gonzalez, Esq., President, Medicare & Medicaid Compliance

Heather Schwartz Sanderson, Esq., Chief Legal Officer, Franco Signor LLC

About Rafael Gonzalez, Esq.

Rafael is President of Medicare and Medicaid Compliance, an entity dedicated to providing medicare and medicaid education to the liability, no-fault, and work comp industries. He is an attorney with extensive expertise in auto, medical malpractice, products liability, nursing home, med-pay, and workers compensation claims, as well as social security, medicare, medicaid, and affordable care compliance. He can be reached at [email protected] or 813.967.7598. He is active on LinkedIn, Twitter, Facebook, Instagram, and YouTube.