Strategies to Simplify Workers' Compensation Medicare Set-Asides (WCMSAs)
There's no question that workers' compensation Medicare set-asides create headaches for many attorneys. Nonetheless, it is imperative that attorneys know the ins and outs of WCMSAs, both so they can protect Medicare's interests and secure more advantageous settlements for their clients. Strategies to reduce allocation amounts, knowing how the workers' compensation review contractor reviews settlement proposals, and simply understanding the pros and cons of structured settlements vs. lump sums can all put more money in your client's pocket. Don't miss out on this valuable overview of WCMSAs - register today!
- Determine what Medicare's reimbursement rights are when they make a conditional payment on an outstanding medical bill.
- Effectively protect Medicare's interests, even in cases that do not meet the minimum review thresholds for a WCMSA.
- Ensure the allocation amount of a WCMSA is not too high by using strategies to reduce future prescription drug costs, future medical costs and more.
- Avoid lag time when submitting a set-aside to CMS by recognizing submission pitfalls that lead to delays.
- Calculate whether a lump sum or a structured settlement is more advantageous for funding a workers' compensation Medicare set-aside.
- Ethically handle settlement funds in a dispute.
- Medicare Secondary Payer (MSP) Obligations
9:00 - 10:00, Brent M. Steier
- Statutes and Regulations
- Recent Developments and Case Law
- Compliance Red Flags
- The SMART Act
- MMSEA Section 111 Reporting Requirements
- Determining Medicare Status
- Reporting Requirements
- Medicare Conditional Payments
- Objectives, Statutes, Regulations and Case Law
- How Much can Medicare Recover?
- Who is at Risk?
- Reporting the Settlement
- Challenging Conditional Payment Claims
- Preliminary Considerations for Workers' Compensation Medicare Set-Asides (WCMSA)
10:15 - 11:15, Brent M. Steier
- WCMSA Policy Memos and Reference Guide
- Determining if a WCMSA is Necessary
- Medicare Review Thresholds 1 and 2
- Reasonable Expectation of Medicare
- When to Settle?
- WCMSA Contingency Settlements
- The CMS Definition of Total Settlement Amount
- Non-Threshold Cases and Protecting Medicare's Interests
- Submitting a WCMSA to CMS: Strategies for Quick Responses
11:15 - 12:15, Raven N. Matthews Pillette
- The WCMSA Submission Package: Ensuring Quick Turn-Around Time
- CMS Document Requirements Checklist
- The Cover Letter
- Treating Physician Opinion
- Future Treatment Plan
- Communicating with the Workers' Compensation Review Contractor (WCRC): Overcoming Challenges
- The Submission Portal: Problems and Issues
- The Review Process: How it Works
- Denials and Re-Review Requests
- The Top WCMSA Submission Pitfalls
1:15 - 2:15, Raven N. Matthews Pillette
- Attorney's Duty of Competence, Diligence and Communication
- Identifying and Preventing Conflicts of Interest
- Maintaining Client Confidentiality
- Medical Records Treatment Under HIPAA
- Rules for Handling Clients' Settlement Funds in the Event of a Dispute
- Allocation Reduction Strategies for WCMSAs
2:30 - 3:30, Brent M. Steier
- The Allocation Process
- How the Centers for Medicare and Medicaid Services (CMS) Review Future Costs
- Reducing Allocation Amounts (Rated Age, Future RX Costs, Future Medicals)
- Zero Dollar WCMSA Considerations
- WCMSA Allocation Mistakes Made by Attorneys
- WCMSA Funding and Administration
3:30 - 4:30, R. Scott Iles
- Lump Sum or Structured Settlement? Pros and Cons
- Annuity Issues: Does Medicare Cover 100 Percent When it Runs Out?
- Key Administration Concerns
- Self-Administration vs. Professional Administration
- Reporting Requirements for CMS Compliance
- Improper use of Funds: Risks for Claimants and Attorneys
*Because the rules regarding Medicare set-asides are in a state of flux, the above agenda may not reflect the latest developments. However, faculty will present up-to-date information at the seminar.