The Medicare Secondary Payer (MSP) Statute provides that the centers for Medicare and Medicaid Services (CMS) may pursue damages against any entity that attempts to shift the burden of medical costs to Medicare. The purpose of the MSP statute is to ensure Medicare is only secondarily responsible for payment of medical expenses for Medicare beneficiaries, who were also covered by another type of insurance. Under this statute, CMS has the right to seek reimbursement of medical expenses paid by Medicare that the insurance carrier of self-injured should have paid. Additionally, the statute provides for a private cause of action for double damages against the insurance carrier for failure to provide primary payment or appropriate reimbursement.
This program will provide an overview of the Medicare system and provide participants with a basic understanding of the compliance process.
- Learn to identify impacted claims
- Learn the basics of Medicare Set-Aside (MSA) Arrangements
- Learn about administration of MSA funds
- Learn the various financing options available to the parties
- Learn the differences between Medicare and Medicaid
- The attendee will be able to discuss Medicaid and the special needs trust.
- The attendee will be able to identify the role of the professional administrator.
- The attendee will be able to review the Medicare set-aside arrangement.
8:30 a.m. - 9:50 a.m.
I. Medicare Set-Aside Arrangement Overview
A. Medicare Overview
B. CMS Threshold For Review
C. Medicare Set-Aside (MSA) Arrangements
D. Conditional Payments
E. The Professional MSA Allocator
9:50 a.m. - 10:00 a.m.
10:00 a.m. - 11:15 a.m.
II. Medicare Secondary Payer Statute
A. Medicare Regulations
B. Case Law
C. CMS Policy Memos
D. Legal Considerations
E. Settlement Documents
F. Impact On Liability Claims
G. Preservation Of Medicare Benefits
11:15 a.m. - 12:30 p.m.
III. The Role Of The Professional Administrator
A. CMS Requirements For Administration Of An MSA Account
B. Professional Administration vs. Self Administration
12:30 p.m. - 1:30 p.m.
Lunch (On Your Own)
1:30 p.m. - 2:50 p.m.
IV. Funding And Financing MSA Arrangements
A. Traditional Methodology And Objectives Then And Now
B. The Role Of The Financial Professional
C. The Interplay With MSA Claims
D. Cash vs. Structured Settlements
E. Understanding Annuity Benefits
F. Rated Age
2:50 p.m. - 3:00 p.m.
3:00 p.m. - 4:30 p.m.
V. Medicaid And The Special Needs Trust (SNT)
A. SSI vs. SSD
B. Medicare vs. Medicaid
C. Medicaid Liens
D. Preserving Public Benefits
E. Impact On Claimants And Attorneys