The News You Need for May 29
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The Power of Networking in Workers’ Compensation: Refresh Your Skills
Sarasota, FL (WorkersCompensation.com ) -- In workers' compensation, networking is not just a valuable skill but essential for advancing your career and thriving. As industry events such as educational seminars, conferences, and golf outings become more prevalent with the changing seasons, it is necessary to refresh your networking strategies. You can optimize your networking efforts by understanding the importance of networking, identifying where to start, and preparing effectively. Consider using networking to your advantage to enhance your experience in the workers' compensation industry. You never know where the journey will take you!
Why Network?
Networking offers numerous benefits, especially in the workers' compensation industry. Establishing and maintaining business relationships can lead to new opportunities, collaborations, and career advancement. Connecting with peers, mentors, and industry leaders provides a support system and valuable guidance. Sharing your knowledge and staying informed about industry trends can improve your expertise and profitability. Connecting with experienced professionals can provide guidance and advice to help you grow your career. Networking is not just about work but also about finding common ground and building relationships through shared interests.
Key Points:
- Building relationships: Establishing and maintaining professional relationships can lead to new opportunities, collaboration, and career advancement. Connecting with others in your industry can provide a support system, which can be vital during times of change or career challenges.
- Making connections: Networking helps you connect with peers, mentors, and industry leaders. These connections can provide valuable advice and information, as well as support and career advancement.
- Increasing knowledge: Sharing knowledge and staying informed about industry trends can improve your expertise and profitability. Having good information can help you make better business decisions. It can also establish you as a competent professional in your field.
- Career advice and support/counseling: Connecting with experienced professionals can provide advice and guidance to help your career development. Mentoring can offer new perspectives and advice. It can also provide support and encouragement throughout your career.
- Sharing outside interests: Networking isn't just about work but also about finding common ground and building relationships through shared interests. Finding connecting points within another person can make networking more enjoyable and less stressful and help you form more profound, meaningful relationships.
Where to Start?
Networking can take on formal and informal forms, and knowing where to begin is essential. Start by recognizing your strengths and how you can utilize them in networking situations. Whether you're an extrovert who enjoys large gatherings or prefers one-on-one conversations, tailor your approach to your personality. Remember that men and women often have different networking styles, which may impact your strategy. Men can blend business and friendships more efficiently and have broader networks, while women focus on developing deep, trusting relationships.
1. Assess your skills: Consider your strengths and how to utilize them in networking situations. Whether you're an extrovert or an introvert, adapt your approach to your personality. Being true to your authentic self will help you feel more at ease and confident when networking.
2. Understand gender differences: Men and women often develop different networks. Men can combine business and friendship more effortlessly, while women focus on building deep, trusting relationships.
3. Set clear goals: Define what you want to achieve through networking, whether finding a mentor, gaining industry knowledge, or discovering new job opportunities. Clear goals can help you stay focused and improve your networking efforts.
4. Understand your energy scale: Not everyone is naturally extroverted. If you're new to networking, set small goals for events. If you have clear intentions about what you want to gain from these events, set a deadline or time commitment during which you will strive to engage to your total capacity.
Networking: Formal and Informal
Engaging in formal and informal networking is crucial for advancing your career. Formal networking involves attending industry-specific events, such as legal networking sessions, conferences, and seminars, which provide structured opportunities to meet and interact with professionals in your field. On the other hand, informal networking can involve anything from casual social gatherings to spontaneous conversations with coworkers. Both types of networking are essential and can complement each other in building a solid professional network.
Here are some tips to enhance your networking:
- Participate in professional groups: Join bar associations, industry-specific groups, and professional organizations related to workers' compensation. These groups offer valuable networking opportunities and provide resources and support for your professional development.
- Attend networking events: Take advantage of formal events like networking sessions, educational events, conferences, and seminars. Be proactive in introducing yourself and interacting with others to make valuable connections and gain industry insights.
- Connect informally: Networking is broader than formal events. Build relationships within your organization and connect with colleagues at all levels to create a solid internal network.
Networking within your Organization
Networking within your organization is just as important as networking externally. Interacting with colleagues at all levels, from peers to senior management, is crucial. Sharing your story and being authentic can lead to meaningful connections. It's essential to reconnect with your contacts regularly to maintain relationships. Additionally, sharing opportunities and offering help wherever possible can help foster a strong support network.
Here are some key points to keep in mind:
- Connect with colleagues at all levels, from peers to senior management. Sharing your story can lead to meaningful connections, and being yourself helps build authentic relationships.
- Reconnect with your contacts regularly to keep relationships alive. Sharing opportunities and offering help where possible fosters a supportive and dynamic network.
- Participate in company activities and projects and utilize internal networking events and initiatives to build a solid internal network.
Preparing for Networking Events
Preparation is crucial for successful networking. Before attending an event, research the attendees and identify the key individuals you want to connect with. Bring essential business cards and relevant materials that represent your professional identity. Plan and practice your introduction to ensure it is concise and engaging. Be ready to ask and answer questions to facilitate meaningful conversations.
- Research participants: Identify the key individuals you want to meet and understand the purpose of your attendance to plan your approach and increase the likelihood of meaningful conversations.
- Connect on social media: Reach out to key individuals before the event to establish informal connections. Connecting on social media can help you initiate friendly exchanges in person and learn important information about the people you want to communicate with.
- Bring the essentials: Remember to bring business cards and any relevant materials to leave a lasting impression and help contacts remember you.
Starting and Maintaining Conversations
Starting and maintaining conversations can be challenging, but it is essential for effective networking. Begin with a friendly greeting and follow up with open-ended questions, such as "What brings you to this program?" or "How did you get started in the workers' compensation field?" Share your professional background and experiences to build rapport. Stay updated on current industry trends and news to engage in meaningful discussions. Show genuine interest in each other's stories and experiences, and follow up after the event with a personal message to strengthen the connection.
Key Tips:
1. Start with confidence: Begin with a friendly greeting and follow up with open-ended questions to start the conversation naturally.
2. Practice positive body language: Maintain open body language, keep your shoulders back and down, and keep your arms relaxed. Avoid crossing your legs while standing, as it may indicate insecurity. Display confidence by spreading your feet hip-width apart.
3. Tell your story: Share your background and professional experiences to build relationships and provide context for your conversation.
4. Stay informed: Keeping up with current industry trends and news will help you engage in meaningful discussions, demonstrate your knowledge and engagement in your field, and make you a more attractive networking contact.
Networking at Social Events
Social events, like golf outings, offer a more relaxed environment for networking. It is important to be proactive, participate in activities, and engage with others casually. Women should actively participate in women-focused networking groups and create support networks. These groups should also include men to ensure a diversity of perspectives. Attending social events can help establish deeper connections and make networking more enjoyable.
- Be sociable: Don't hesitate to engage in activities and connect with others in an informal setting. Trying something new can help you establish connections and build relationships, making networking more enjoyable.
- Support women's networking groups: Women should actively participate in women-focused networking groups and establish support networks. Men should also be included in these groups to ensure diverse perspectives and inclusive networking.
- Attend social events: Participate in social events such as golf outings. These events provide a comfortable environment for networking and can help you establish more meaningful connections.
- Have fun! Life is short. Laugh, engage in activities you enjoy, and have a good time responsibly.
Utilize the Power of Networking
Networking is a potent tool that can significantly impact your career in workers' compensation. Effective networking can open doors to new opportunities and enhance your professional growth, whether attending a formal conference or a casual golf outing. Remember, networking does not just mean exchanging business cards; it is about building lasting relationships and fostering a supportive professional community. Adopt these strategies to make the most of upcoming events and improve your networking skills. By doing so, you can ensure that you stay connected, informed, and prepared to pursue new opportunities in the workers' compensation industry.
Case Management Focus: 2024 Professional Reading List
Welcome to the 2024 Professional Reading List. I create this list each year at this time to share books and e-letters that help me keep my finger on the pulse of the healthcare industry. I hope you will check out each of these resources to learn about each publication and subscribe to those e-letters that ‘talk to you’ and ‘help you’ navigate the complex healthcare system.
To succeed, we all need to read and stay current on clinical innovations and practice changes. The books, e-letters, and special reports shared in this year's Professional Reading List will help you become better informed and aware of how you can improve your skills and competencies.
Review the list, click on the links, choose the ones you want to subscribe to, and bookmark. Most of the e-letters are free, so feel free to subscribe so you get them in your inbox.
If you get an e-letter that has educated you this past year, please email me the name and link so I can check it out and add it to the list!
Let’s start with new books that have come out this year that were important to the times we work!
Each year, I cover new books written by Nurses, case managers, and other healthcare professionals that are impacting healthcare. If you know of other books that should reach healthcare professionals, please let me know so I can add them and be on the lookout for them as they are published.
Dr. Colleen Morely, Case Management Leader and Hospital Case Manager wrote two essential books every department should have. They are:
A Practical Guide to Acute Care Case Management: The Day to Day “How To Be An Acute Care Case Manager” Resource. This book is an excellent guide and reference for case managers entering the acute care practice setting. It accurately provides clear information and training regarding the role of an acute care case manager, along with case studies and expert mentoring, all in a single resource. To learn more, https://www.amazon.com/Practical-Guide-Acute-Care-Management/dp/1943889163
A Practical Guide to Hospital Readmission Reduction. In a world where case managers, hospital administrators, and care coordinators face the daunting challenge of reducing hospital readmissions, the need for a practical guide to navigate this complex landscape has never been more pressing. Enter ‘A Practical Guide to Hospital Readmission Reduction’, a captivating and indispensable resource that offers a roadmap to break the cycle of rehospitalization and ensure optimal patient outcomes. To learn more: https://bluebayoupress.com/books/a-practical-guide-to-hospital-readmission-reduction/
Dr. Ellen Fink Samnick, Social Worker and Case Management Leader, wrote;
The Ethical Case Manager: Tools and Tactics. Whether you are a health professional transitioning to case management or already working, The Ethical Case Manager: Tools and Tactics is your indispensable resource to guide case management's unique legal and ethical practices. The Ethical Case Manager: Tools & Tactics?provides a practical approach to addressing the healthcare industry’s most compelling ethical dilemmas. Knowledge of the ethical situations case managers face daily is blended with regulatory requirements, ethical decision-making models, and critical resources. To learn more, visit https://rb.gy/slepse
Dr. Samnick has a new book coming soon. The title of the book is Behavioral?Health for Case Management. It should be out this fall. Here is the link from the publisher to learn more and to receive updates.?https://bluebayoupress.com/books/behavioral-health-for-case-management/
Michelle Crook, BSN, RN, CCM, wrote: The Wellness Journal for Nurses. The book is a valuable tool for all nurses, regardless of their practice setting or years of experience. Step into this guided self-care journey and enjoy the support, positivity, and encouragement. Michelle is a Certified Case Manager and Board-Certified Patient Advocate with a wealth of experience in clinical and business healthcare settings. She has been a strong patient and family advocate and a nurse empowerment leader throughout her nursing career. Michelle is also a published author; her love of writing is evident in her numerous articles, blogs, patient education pieces, and other creative works. The publication of this Wellness Journal for Nurses has been on her bucket list for many years, and she is thrilled to share it with you! To learn more: https://www.amazon.com/Wellness-Journal-Nurses-Journey-Self-Care/dp/B0CPT33ZYR
Dr. Mansur Hasib recommended two books. Dr. Hasib outlines approaches and pragmatic solutions to developing your brand. To make it relatable and back his approach, he writes from experience and shares his journey in the cybersecurity industry.
领英推荐
"Bring Inner Greatness Out: Personal Brand" is about individual self-discovery, economic empowerment, career transitions, and breakthrough professional success. https://www.amazon.com/dp/B08L5Y7DF1
?"Cybersecurity Leadership'' was written to foster organizational innovation culture, developing leaders and teams, ethical leadership, and organizational change management. https://www.amazon.com/dp/1087981123
Susan Hassmiller wrote: Taking Action: Top 10 Priorities to Promote Health Equity and Well-being in Nursing?1st Edition”.
The crucible of the global pandemic, racial injustice, and a crippling nursing shortage has sparked increasing calls for nursing to address its problems from inequity to structural racism. In response, authors Susan B. Hassmiller and Gaea A. Daniel enlisted nearly 70 national and international nursing leaders to tackle the profession's most pressing issues.
Taking Action: Top 10 Priorities to Promote Health Equity and Well-Being in Nursing?spotlights 10 critical themes through data, essays, discussion points, and action items, equipping readers to move beyond conversation to action. To learn more, visit: https://www.amazon.com/Taking-Action-Priorities-Promote-Well-Being/dp/1646482026
Kasey Pacheco wrote The Burnout Prevention Workbook to help nurses and business leaders like you find practical strategies to help navigate the complex blend of personal and professional responsibilities. To learn more, visit: https://www.preserversoflife.com/webinar-registration
Nurse leader Sharon Weinstein and her colleague Dina Readinger produced Healing Healthcare: Evidenced-Based Strategies to Mend Our Broken System. The book explores the intricate challenges within the healthcare landscape post-pandemic and offers solutions for change. They brought nurse leaders from academia, practice, and the community together to share their expertise and provide tips that readers can use in their settings. Healing Healthcare is a collaborative effort that serves as a beacon of hope, paving the way for a truly healed and resilient healthcare system. To sign up for updates and the release date, click here. https://healbrokenhealthcare.com
Professional Newsletters and Publications
Keep up to date with news from your State Board and Professional Organizations. In my case, I am a nurse and look forward to getting Florida Nurse, ?the monthly newsletter from the Florida Board of Nursing. To learn more, go to: https://www.floridanurse.org/page/TFN
American Nurse Journal, the official, clinically and career-focused journal of the American Nurses Association (ANA), is a fresh voice of nursing across America. The printed journal reaches more than 200,000 dedicated nurses in many specialties and practice settings, and the site serves over two million visitors each year. American Nurse Journal is a peer-reviewed journal indexed in the Cumulative Index to Nursing and Allied Health Literature (CINAHL). CINAHL databases are the most widely used and respected research tools for nurses, students, and allied health professionals around the globe. Here is a link to review subscription options: https://www.myamericannurse.com/digital-journal-subscribe
CMSA Newsletter: Keep up to date on what’s happening nationally and with the local chapters of the Case Management Society of America is possible by reading the organization's monthly newsletter. To learn more, visit: https://www.naylornetwork.com/cmsapulse/newsletter-v4.asp?issueID=91077
CMSA Advocacy: In these disruptive times, staying updated with local, state, and Federal Lawmakers is essential. The Case Management Society of America has a proactive public policy committee that supports policies and initiatives that are important for case managers, the patients they serve, and the healthcare systems and payers that pay the claims. To learn more https://cmsa.org/advocacy
CMSA Today: CMSA Today is the official publication of the Case Management Society of America. The magazine lays the body of knowledge for case managers in all settings. To read past issues, go to? https://cmsatoday.com
CMSA Blog: Stay informed on the most recent updates and best practices for case managers. Gain insight from peers in the field as well as leading experts. From legislative initiatives to real-world applications for the latest practices, the CMSA Blog is the go-to resource for new and seasoned case managers. Find every perspective HERE! https://cmsa.org/publications/blog
Note: Note: All of these publications offer opportunities for you to write and share best practices. Here is a link to the author's guidelines. https://cmsatoday.com/author-guidelines
Industry E-letters:
E-newsletters are composed of short articles that share information on various topics. I get some newsletters daily, weekly, monthly, or annually. I scan these as they come across my desk. Occasionally, I comment after I read an article and feel I can contribute and share advice or leave an opinion. Sometimes, I will write to the editor of the e-letter if I am so moved. Here is a sampling of some e-newsletters that come across my desk daily, weekly, or monthly. Most of these are free, so check them out and subscribe so you can keep your finger on the pulse!
AHIMA: The American Health Information Management Association (AHIMA) is the leading voice and authority in health information, wherever it is found. Our people work at the intersection of healthcare, technology, and business. To learn more, visit: https://www.ahima.org/news-publications/publications/newsletters ? AHIP SmartBriefs: AHIP is the national association whose members provide health care coverage, services, and solutions to hundreds of millions of Americans daily. Here is a link to their Newsletters: https://www.ahip.org/ahip-newsletters ? Bearingon.Health is a new e-letter that delivers original content, curated highlights from the web, the latest trends, and breakthrough analyses directly to your inbox. Whether you're part of a healthcare provider, health plan, pharmaceutical, digital medicine company, or wellness enthusiast, join our community to remain informed and empowered. Explore the ever-evolving impact of digital technology on health and healthcare today and tomorrow. I have had the privilege of writing several articles to represent the consumers and the healthcare team who are learning how to use new technologies meant to improve care delivery. To learn more and subscribe, go to https://www.bearingon.health/home Becker’s Healthcare: Becker's Healthcare is the go-to source for healthcare decision-makers and one of the fastest-growing media platforms in the industry. Through print, digital, and live event platforms, Becker's Healthcare equips healthcare leaders with the information and forums they need to learn, exchange ideas, and further conversations about the most critical issues in American healthcare. To learn more, visit: https://www.beckershospitalreview.com ? ? Healthcare Daily Dive: Today’s news and insights for healthcare leaders. A good e-publication that allows you to choose e-letters on several topics. To learn more, visit: https://link.healthcaredive.com/view/57239dc1a227620b268b4793l44tg.o5s/dd33187a ? HealthExecWeek provides a weekly wealth of business intelligence and insights covering the spectrum of subjects filling the healthcare arena. To learn more, visit https://healthexecweek.com ? Managed Care Matters is an e-newsletter written by Joseph Paduda from Health Strategy. ?Associates deliver timely and actionable advice to help clients build their brands, enter new markets, differentiate their services, increase sales, and make wise acquisitions. We bring an unbiased, open approach to your company's challenges and opportunities and draw on years of experience, continuous industry analysis, and a keen understanding of economic drivers to help you make the right moves. To learn more, visit https://www.joepaduda.com ? MedPage Today is a trusted source for clinical news coverage across medical specialties. To learn more, go to: https://www.medpagetoday.com ? Medscape for Nurses: The publication offers the latest medical news and expert perspectives across essential point-of-care. Medscape membership is free and gives unlimited access to the entire network of sites and services. To learn more: https://www.medscape.com/for-you ? National Academy of Medicine Perspectives: National Academy of Medicine (NAM) is one of three academies that make up the?National Academies of Sciences, Engineering, and Medicine (the National Academies) in the United States. The e-newsletter covers interesting topics related to health and science. To learn more: https://nam.edu/publications ? NEJM Catalyst brings together healthcare executives, clinical leaders, and clinicians to share innovative ideas and practical applications for enhancing the value of healthcare delivery. Our digital, peer-reviewed journal, live-streamed events, and Insights Council provide real-life examples and actionable solutions to help organizations address urgent health care challenges. To learn more, visit https://catalyst.nejm.org/about ? Numerof & Associates: An e-newsletter that looks at changes in the macro environment – in market expectations, regulation, technology, or the competitive landscape – often disrupts business models. We connect the dots, translating market shifts into clear implications, precise, actionable insights, and roadmaps for people, processes, and strategy. To sign up for their newsletter, go to https://nai-consulting.com ? SCORE is a nonprofit association dedicated to helping small businesses get off the ground, grow , and achieve their goals through education and mentorship. Because our work is supported by the U.S. Small Business Administration, and thanks to our network of 10,000+ volunteers, they can deliver our services at no charge or at an affordable cost. SCORE programs can be found across the country. Here is the SCORE program that I subscribe to in my area https://www.score.org/broward ? ? Wellworth Advisors: This beautiful e-letter shares information we can all use as we navigate the complex healthcare system. Please read it for yourself and share it with others. Check it out! https://www.wellworthadvisors.com ? WorkersCompensation.com is the nation's largest, most visited, and most trusted source of essential services and information for the workers' compensation community. We offer the latest news, event calendars, state rules, statute updates, and numerous other services built to help thousands of workers' compensation professionals excel at their jobs every day. Editors Note: I write a weekly column for this newsletter. Check out my column Case Management Focus at https://www.workerscompensation.com/tag/case-management ? Offerings from Anne Llewellyn, YOUR NURSE ADVOCATE I also offer some of the writings/publications that I have done over the past few years. Feel free to download them, read them, and share them. To access it, visit the Resource Section of my website, Nurse Advocate. https://nursesadvocates.com/resources Please also subscribe to my Blog, Nurse Advocate. Most Tuesdays at 8 am, I send you my weekly Blog Post to allow you to ponder a topic or a situation that I share to raise awareness, educate, empower, and inspire you to make a difference. WE ARE ALL IN THIS TOGETHER! To subscribe to the Blog, go to https://nursesadvocates.com/blog ? This year's Professional Reading list offers you information you can use to stay current and contribute to improving our complex healthcare system. If you have publications you would like to add, please email me at [email protected] ?
Workers Injured by Falling Debris on I-10, Among Other Incidents
San Antonio, TX (WorkersCompensation.com ) – Two workers were injured by a piece of flying debris from a highway construction project, one of several incidents to affect workers over the last few weeks.
According to the Texas Department of Transportation (TXDOT), in late April, workers were removing a temporary beam on the flyover ramp on the I-10 interchange with 1604 when I fell and struck an aerial lift with two workers inside. TXDOT said "this temporary beam is used during formwork and is different from the large steel beams that permanently support the flyover ramp.” The workers were transported to the hospital and treated for serious injuries.
TXDOT said they were working with Williams Brothers Construction, the firm handling the work on the flyover ramps to ensure they are following all safety protocols and guidelines. The department said an emergency safety meeting was held with the company in order to review safety protocols, and that it is conducting an investigation into the incident.
Williams Brothers Construction was previously involved in employee injuries. In 2016, a Williams Brothers Construction worker, Gerardo Lopez, fell to his death while working on a highway ramp. In 2012, another employee fell to his death working on a highway flyover project. Victor Trevino lost his footing, officials said, and fell 70 feet. Police as the time said Trevino was wearing a safety harness, but it wasn’t connected to anyone.
In West Hartford, Conn., a worker was injured when a man from Chicago attacked him during an armed robbery.
Police said the Advance Auto Parts employee was working Tuesday, May 21 when Luis Pagan, 38, entered the store with a weapon and robbed the store. The employee suffered non-life threatening injuries during the incident where Pagan left with an undisclosed amount of money. Pagan fled the scene on a bike, and was apprehended by police blocks from the store.
Police recovered the money and arrested Pagan. He was charged with a number of crimes, including first degree robbery, criminal mischief, assault, illegal uses of a facsimile firearm and possession of drug paraphernalia.
In Gatlinburg, Tenn., an employee was injured when they fell down the hillside of Ober Mountain.
Earlier this month, the employee was working on the mountain coaster at Ober Mountain when they fell at least 20 feet and had to be extracted from the mountain.
Seth Butler, the director of operations and communication for the City of Gatlinburg, said the employee suffered a medical emergency and fell down the hillside. Following the fall, the employee was conscious and alert enough to call for other employees to help him as he suffered neck and back pains, as well as a laceration on his head. The employee was extracted from the hillside by emergency personnel and taken to UT Medical Center for further treatment.
And in Troy, N.Y., crews from a private electrical firm were injured as they worked on a hydro-electric dam.
Officials said that the crews were working at the Mount Ida Hydro-Electric Dam on May 24 when an electrical event happened that caused the employees to suffer injuries.
“Some sort of electrical event happened that caused the equipment to arc and resulted in their burns,” Fire Chief Rich Cellucci told local news outlets.
Cellucci said the equipment caused a breakdown of gas which produced a plasma spark and burned the employees.
“Significant burns in varying degrees on various parts of their body,” Cellucci said. ”One of them was transported by ground ambulance to Albany Medical Center, and the other two were each transported by helicopter to a burn center.”
The incident is being looked into, officials said.
“It’s being investigated. I believe the state and OSHA will be coming in the plant. The hydro plant has been shut down. I have talked to our chief multiple times this morning, getting updates and just so you know, our thoughts are with the victims,” Troy Mayor Carmella Mantello said.
Relevate Power LLC owns the Hydro-Electric dam which is operated by Ampersand New York Operations Co. The companies said in a statement that the plant was shut down until further notice.
“Mount Ida Hydro officials are working to support the investigations of local firefighters and the U.S. Occupational Safety and Health Administration,” the companies said.
Upcoming Reporting Changes Emphasize Importance of Post-Settlement Workers’ Compensation MSA Administration
General Counsel & Vice President of Claims Solutions | J29
As previously reported on in www.workerscompensation.com , the Centers for Medicare & Medicaid Services (“CMS”) plans to implement Sec. 111 reporting requirements relative to workers’ compensation settlements that include a Medicare Set Aside (“MSA”). Understandably, much has been covered regarding the technical details surrounding this upcoming change. However, the underlying basis and consequences haven’t been a particular area of focus – and therefore, will be covered here.
Background
Up until now, Sec. 111 reporting is in place to ensure proper coordination of benefits (determining primary versus secondary payer responsibility) and to facilitate recovery of conditional payments. More broadly, and in CMS’ own words , as they indicated in their April 16, 2024 webinar related to these upcoming changes: “The S111 reporting process is just part of the Medicare Secondary Payer (MSP) provisions that continue to protect Medicare Trust Funds. Protecting the Medicare Trust Funds means that CMS must make every effort to ensure that it does not pay for items and services that certain health insurance or coverage is primarily responsible for paying.”?
On April 4, 2025, CMS will mandate that Responsible Reporting Entities (RREs) – i.e., workers’ compensation insurance carriers and self-insureds – report workers’ compensation settlements, known in the parlance as Total Payment Obligation to Claimant (TPOC) events associated with MSAs. It’s important to note that these upcoming reporting changes: ?
Why does CMS want to know about workers’ compensation settlements with MSAs? As will be covered below, CMS wants to know about workers’ compensation settlements with MSAs to ensure proper post-settlement coordination of benefits. In other words, CMS wants to make certain an injured individual doesn’t purchase the proverbial boat with their MSA.
Post-Settlement Coordination of Benefits of MSAs
An MSA is a determination of post-settlement Medicare-covered healthcare needs associated with the workers’ compensation injury and is in place to prevent a cost-shift to the Medicare program. Post-settlement, CMS coordinates benefits with MSAs by flagging a Medicare beneficiary’s Common Working File (“CWF”) with an MSA marker denoted as a “W” code. The CWF system is used by CMS and Medicare Administrative Contractors (MACs) as a sole data source where MACs and other contractors can verify eligibility and coordinate benefits for approval and payment of claims. See?Medicare Claims Processing Manual, Chapter 27 - Contractor Instructions for CWF . Going back to October of 2009, CMS has utilized this “W” code to flag a beneficiaries’ CWF, “in order to prevent Medicare from paying primary for future medical expenses that should be covered by workers’ compensation Medicare set-aside arrangements (WCMSA).” See?MLN Matters Number: MM5587 .?
Post-Settlement coordination of benefits with MSAs is “…accomplished by placing an electronic marker in CMS’ systems used to pay or deny claims. That marker is removed once the beneficiary can demonstrate the appropriate exhaustion of an amount equal to the WCMSA plus any accrued interest from the account.” See?WCMSA Reference Guide, v4.0, Sec. 18 .?“Additionally, the contractor [i.e., the Benefits Coordination & Recovery Center (BCRC)] must ensure that Medicare makes no payments related to the WC injury until the WCMSA has been used up. This is accomplished by placing an electronic marker in CMS’ systems used to pay or deny claims. That marker is removed once the beneficiary can demonstrate the appropriate exhaustion...” Id.
Critical Nature of Post-Settlement Administration & Attestation Reporting ?
Following a workers’ compensation settlement, an injured individual can act as their own administrator. However, it is “highly recommended” by CMS that a professional administrator is utilized. See WCMSA Reference Guide, v4.0, Sec. 17.1. This is for good reason, especially in light of the upcoming reporting rules where CMS will have unprecedented insight and visibility into all workers’ compensation settlements with MSAs.
CMS requires the following with respect to administering an MSA:
The forthcoming Sec. 111 changes requiring MSA information related to workers’ compensation settlements indicates CMS will be increasing post-settlement oversight and potential enforcement. CMS indicated in their November, 2023 webinar that the information reported via Sec. 111 would be used to flag a beneficiary’s CWF to prevent payment for medical services related to the work-related injuries which were accounted for in the MSA.?
Enforcement would come by way of CMS denying benefits if it was determined that MSA funds were inappropriately spent, or perhaps a denial would occur in relation to the agency’s non-submit policy found in Sec. 4.3 of the WCMSA Reference Guide:
As a matter of policy and practice, CMS may at its sole discretion deny payment for medical services related to the WC injuries or illness, requiring attestation of appropriate exhaustion equal to the total settlement as defined in Section 10.5.3 of this reference guide, less procurement costs and paid conditional payments, before CMS will resume primary payment obligation for settled injuries or illnesses, unless it is shown, at the time of exhaustion of the MSA funds, that both the initial funding of the MSA was sufficient, and utilization of MSA funds was appropriate. This will result in the claimant needing to demonstrate complete exhaustion of the net settlement amount, rather than a CMS-approved WCMSA amount.
Focus on Post-Settlement Administration to Avoid Denials
To avoid potential denials, it will be critical for injured individuals to properly administer their MSA – which includes accurate and timely reporting of attestation information. For this reason, as CMS does, it is highly recommended that injured individuals utilize a professional administrator. With the forthcoming Sec. 111 reporting changes, CMS will now have exceptional visibility over all workers’ compensation settlements with Medicare beneficiaries involving MSAs – not just those that were voluntarily submitted.
While it is crucial for claims payers to prepare for upcoming MSA reporting changes, it is equally important to focus on proper post-settlement administration. Attention must be given to the potential non-compliance or mismanagement of the MSA that may result from self-administration.
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Author Bio Shawn Deane General Counsel & Vice President of Claims Solutions | J29 [email protected] ?? (866) 529-6771 www.j29inc.com
As General Counsel & Vice President of Claims Solutions, Shawn Deane leads J29’s legal and Medicare Secondary Payer (MSP) services team. Shawn is a practicing attorney and has over 16 years of experience in Medicare compliance, workers’ compensation, and insurance claims. He was previously General Counsel & Senior Vice President of Risk Management & Compliance at the nation’s largest professional administrator of Medicare Set Asides. Prior to that he was Vice President of Medicare Compliance & Policy at one of the country’s largest Medicare Set Aside vendors. He’s an industry expert and thought leader in workers’ compensation, Medicare Set Asides (MSAs) and Medicare compliance.
About J29
J29 Inc. is a women-owned business that offers Medicare Secondary Payer (MSP) compliance services providing Medicare Set Asides (MSAs), conditional payment / lien services and related solutions to all workers’ compensation stakeholders – including carriers, self-insureds, third-party administrators, and attorneys.
Attorney at Law
5 个月Thanks for sharing!