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 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
Medicare Conditional Payments
There will be a discussion of what conditional payments are and who to address them.
MSA Administration and Custodial Accounts
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.
MSP Case Law Overview
A review of current legal cases relative to the Medicare Secondary Payer statute.
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
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
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
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
A review of current legal cases relative to the Medicare Secondary Payer statute.