Join Us Feb 23-25 in DC for Medicare Secondary Payer Master Class

Hope you can join us at the most comprehensive Medicare Secondary Payer educational event, specifically tailored for liability, no-fault, and work comp payers dealing with mandatory reporting, conditional payments, and set aside compliance and legal issues.

Rafael Gonzalez, Esq., Cattie & Gonzalez, PLLC

If you are a primary payer in liability, no-fault, or work comp claims, then you don’t want to miss your chance to get the latest developments in mandatory insurer reporting, conditional payments, Medicare set-asides, and Medicare Secondary Payer compliance at the?RISE 7th Annual?Medicare Secondary Payer Master Class, February 23-25, at the?Kimpton Hotel Monaco?in Washington, D.C.?

I am honored and proud to again chair this live event, designed for mid-to-senior-level management professionals responsible for all aspects of Medicare secondary payer compliance. It will feature a three-part preconference workshop, 18 expert speakers, and 20 sessions. The popular conference requires proof of COVID-19 vaccination to attend. You may register?here.

RECENT MSP CLASS ACTION LITIGATION

For the first time ever, this year's Master Class will provide a comprehensive analysis on recent MSP class action litigation during a half-day, three-part pre-conference workshop, in the afternoon of Wednesday, Feb. 23.

• Jennifer Jordan, an MSP consultant, will provide an introduction to MSP recovery as the MSP enforcer during the first part of the workshop. Attendees will identify the litigants involved in MSP recovery efforts, assess who these litigants represent, understand their objectives, and explore where they are receiving their funding.
• The second part will focus on early case law review leading to current class action litigation. Heather Schwartz Sanderson, Esq., president, Sanderson Firm PLLC, will discuss what was learned from early U.S. District Court case law, and will explore U.S. Courts of Appeals adaptations that initiated private causes of action.
• The third section will provide an in-depth look at amended Qui Tam complaint for violations under the MSP Act and state False Claims Act. Rachel LaMontagne, partner, Shutts & Bowen LLP, will assess the background information of the Qui Tam lawsuits, evaluate the “whistleblower” concept and how it could impact the industry, and explore all the documentation needed to submit a civil complaint under the seal of the court to ensure accuracy and compliance.

LEGISLATIVE AND REGULATORY UPDATE

If you have attended one of our RISE MSP programs before, then you are familiar with Jay Keese. Jay is CEO of Capitol Advocates, a Washington D.C.-based policy and government relations firm specializing in healthcare issues. For over 30 years, Jay has worked closely with companies in the liability, no-fault, and worker’s compensation industry as well as physician groups, hospitals, device and pharmaceutical manufacturers, employers, payers, and states on health care policy and reforms. Jay has worked extensively on regulatory and legislative reforms to the Medicare Secondary Payer program, and on workers’ compensation pharmacy issues. He manages several major healthcare coalitions, working with providers, patient groups, employers, insurers, and states on critical healthcare delivery reforms.?

This year, Jay will provide us with an update on MSP legislation and regulations. Jay will bring us the latest news on congressional activity pertaining to liability, no-fault, and workers compensation mandatory reporting, conditional payments, and set aside allocations. He will also give us his knowledge and experience on the latest executive regulatory efforts on mandatory reporting civil money penalties, conditional payment pre and post settlement resolution changes, and liability, no-fault, and work comp long anticipated set aside allocation regulations.?

PAID ACT

With the passing of the Provide Accurate Information Directly (PAID) Act in December of 2020, and becoming effective in December 2021, Medicare Advantage and Prescription Drug Plan information is now available to liability, no-fault, and workers compensation payers. Learn all about the PAID Act on Thursday, Feb. 24, the first day of the main conference. We’ll explore the law in three parts: from the reporter’s perspective, from the insurer’s perspective, and from the advantage plan's perspective.

• First, Suzanne Jordan, compliance manager, Broadspire, will lead a discussion on the PAID Act, including its importance, why it was initially introduced, how it will improve the industry, and strategies to maximize components of the law.
• The second part will assess the differences of the PAID Act for key stakeholders. Susan Montoya, R.N., managing director, Medicare & Debt Resolution, Travelers, will assess the benefits of the PAID Act in no-fault and how it is administered, the advantages of the law for workers compensation, and the benefits of the law for liability claim.
• Finally we’ll evaluate the immediate and long-term impacts of the law. Brian Bargender, internal consultant, Humana, and Heather Schwartz Sanderson, Sanderson Firm PLLC, will assess the processes from a payer related to the PAID Act when seeking reimbursement, discuss the information that should be and should not be shared with the plaintiff counsel?and why; and will review the immediate impacts the PAID Act has had on the industry, and?speculate the future impacts over the next three to five years.

MEDICARE SET-ASIDES

The afternoon of the first day of the main conference will explore best practices for traditional medically based Medicare Set-Asides, evidence based MSAs, data based MSAs, legally based MSAs, as well as the major differences between work comp and liability set aside allocation arrangements.

• Nancy Harple, claims supervisor, Chesapeake Employers’ Insurance Company, and Monica Williams, RN, CEO and president, Medicare and Workers Compensation Consultants, will explore the traditional Medicare Set-Aside System. They’ll discuss allocation and submission, the documentation needed for a successful claim, and best practices when dealing with Medicare to achieve desired outcomes.
• Next, we’ll examine alternative Medicare Set-Asides to assure Medicare’s future interests. Amy?Bilton,?J.D., shareholder,?Nyhan Bambrick Kinzie & Lowry, will dissect medical guidelines to understand the process, and explain the documentation that is necessary and unnecessary. She’ll also analyze legally based Medicare Set-Asides to identify legal issues, case law, and statute that are valuable to the case.
• Rasa Fumagalli, J.D., director of MSP compliance, Synergy Settlement Services, will explain how to protect Medicare’s future interest without a set structure. She’ll analyze the differences between Liability and Workers Compensation Medicare Set-Asides; assess how to prepare accurately with lack of structure, no set process, reference manual, or guidelines.
• Next, we’ll explore alternative Medicare Set-Aside approaches with John V. Cattie, Jr.,?managing attorney,?Cattie & Gonzalez, PLLC. He’ll go over the process of self-allocation based on individuals’ medical needs for life and explain the pitfalls when utilizing a medical opinion related to future medical needs. Cattie will also explain how to capitalize on medical cost projection created from advice from multiple professionals to ensure an accurate assessment. We’ll also learn how to utilize legally based Medicare Set-Asides that are created based on legal principles, instead of?medial recommendations.

LIABILITY CONDITIONAL PAYMENTS?

On Friday, Feb. 25, we will evaluate the responsibility of the plaintiff and defendant for conditional payments related to liability, no-fault, and work comp claims, including dispute, redetermination, reconsideration, and hearing process.?

• Jason Lazarus, Founder, Chief Executive Officer,?Synergy Settlements, will lead the plaintiff's presentation, discussing the documentation needed to notify Medicare of the claim, preparing for?conditional payment letters and final demand from the BCRC, and analyzing the requirements necessary to appeal BCRC, Qualified Independent Contractor, and US Treasury decisions.
• On the other side, Catherine E. Goldhaber, Partner in Charge,?at Hawkins Parnell, will address specific party reimbursement to Medicare to avoid costly long-term complications, will analyze documentation, including proof of?reimbursement,?to ensure compliance?if claimant is represented, and will discuss how to create and implement?best?practices to ensure that all settled cases are correctly maintained to evade future problems?if?claimant?is unrepresented.?

NO-FAULT CONDITIONAL PAYMENTS

The second day of the main conference will take place Friday, Feb. 25 and will include topics related to no-fault condition payments from both the plaintiff and defense perspective.

• Steven Shaw, attorney and certified Medicare Secondary Payer professional, Shaw Legal Solutions, and Ryan Weiner, chief operating officer, MASSIVE: Medical and Subrogation Specialists, will explain the obligations of the plaintiff/lawyer. They’ll go over the plaintiff’s responsibility related to liens in no-fault cases, explain the process and the information that needs to be provided to Medicare, and process and documentation needed for the Commercial Repayment Center.
• Cattie will return for a session on the obligation of the defendant. He’ll analyze the process to identify the total financial exposure in the policy related to the claim. Attendees will also learn to assess the breakdown of payments related to loss of wages, medical care, and reimbursement to Medicare, including documentation and providing proof of expenses. Cattie will also discuss the timing involved in the claim that potentially can create a responsibility to reimburse Medicare.

WORKERS COMPENSATION CONDITIONAL PAYMENTS?

We will go over the responsibilities of both the plaintiff and defendant and the processes to follow if the employer accepts responsibility for medical, including working with both the Commercial Repayment Center and the Benefits Coordination & Recovery Center to assure compliant processes and timelines.

• Charles R. Medlin, COO and founder, LitPRO, will go over the responsibilities of the plaintiff/lawyer in worker compensation claims. He’ll discuss processes to follow if the employer accepts responsibility for medical, and the expectations of Medicare; the plaintiff’s role post settlement, including timelines and documentation; and the processes of working with both the Commercial Repayment Center and the Benefits Coordination & Recovery Center to assure compliant processes and timelines.
• Next, we’ll evaluate the responsibility of the defendant for conditional payments related to workers compensation. Michelle A. Allan, Esquire, principal, Allan Koba Compliance Solutions, will explore strategies to calculate anticipated payments to Medicare to avoid costly miscalculations. She’ll also help attendees prepare to manage critical information sharing between the injured party and Medicare related to the claim. Attendees will also learn how to identify payments not related to the claim that should be disputed, and prepare for the process including dispute, redetermination, and reconsideration.

Hope you can join us live for RISE 7th Annual?Medicare Secondary Payer Master Class, the industry's most comprehensive Medicare Secondary Payer event. Hope you can join us for this unique conference event, specifically tailored for employers, carriers, third party administrators, and self insured payers, providing an essential guide to the latest developments in Mandatory Insurer Reporting, Conditional Payments, Medicare Set-asides and Medicare Secondary Payer. See you February 23-25, at the Kimpton Hotel Monaco in Washington, D.C.

ABOUT RAFAEL GONZALEZ, ESQ

Rafael is a partner in?Cattie & Gonzalez, PLLC,?a national law firm focusing its practice on federal Medicare/Medicaid secondary payer compliance and legal issues. In addition to assisting clients with Medicare mandatory reporting, conditional payments, and set asides issues, he helps clients with Medicaid third party liability liens and Medicaid special needs trusts issues. He has over 35 years experience in?the liability, no-fault,?and work comp insurance industry.?You can connect with him on?LinkedIn,?Twitter,?Facebook,?Instagramand?YouTube, or reach him at [email protected] or 844.546.3500.