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Baton Rouge, LA 70821

251 Florida St., Ste 314
Baton Rouge, LA 70801

(225) 338-0705
(800) 277-8362

(225) 383-6414




The Program - Day 2

Development of the Medicare Set Aside Cost Projection
This section is designed to teach the development of the MSA Cost Projection and guidelines on when a MSA is appropriate. It will discuss Medicare eligibility and coverage. It will cover not only Medicare parts A, B, C, & D, but also how to determine Medicare Allowable Care. There will also be a discussion regarding settlements of claims prior to CMS approval of a proposed MSA.
  • Medicare Eligibility and Qualifications
  • Trends in WCRC Recommendations
  • Medical Documentation
  • SSDI and Medicare "Reasonable Expectation"
  • Liability MSA vs. Workers' Compensation MSA
  • Costing and Coding
    - Diagnoses Codes
    - CPT Codes
    - HCPCS Codes
    - Workers' Compensation Reimbursement Schedule vs. U&C
    - CMS Calculation Requirements
Medicare Set-Asides Allocations Costing and Coding
This section will discuss the details of costing and coding.

A Brief History of Drug Pricing in Medicare Set-Asides/ Strategic Solutions
Methods of projecting and calculating prescription drugs.

Discussion of CMS Memos
There will be a review of all memos and details regarding CMS written policy and procedures.

Section 111 Reporting
  • Legislation mandating Medicare reporting
  • Purpose of mandatory Medicare reporting
  • Reporting terminology
  • Critical dates
  • Reporting guidelines
  • Queries
  • Reporting expectations
  • Efforts to modify Section 111 reporting requirements
  • Anticipated impact of Section 111 reporting
Medicare Conditional Payments
There will be a discussion of what conditional payments are and who to address them.

MSA Administration and Custodial Accounts
  • Self vs. Professional Administration Requirements
  • Finding the Account
  • Pitfalls of Professional Administration vs. Self Administration
  • Role of a Professional Administrator
  • Payment of Medical Benefits
  • Fee Schedule
  • Usual and Customary
Submission to CMS for Approval of MSA
This section breaks down all the components in putting together a submission to CMS for approval of MSA. There will be a review of the guidelines on when/how to obtain an MSA. There will be an analysis of a CMS approved sample of submission.
  • Guidelines When to Obtain an MSA
  • Sample of CMS Approved Submission
  • Discussion of All Components
  • Allocation Proposal
  • Role Play and Mock MSA
  • A Sample MSA
MSP Case Law Overview
A review of current legal cases relative to the Medicare Secondary Payer statute.