• DAY ONE  | MONDAY

    HISTORY OF MEDICARE SECONDARY PAYER EVOLUTION

    The first section of the program briefly reviews the history and overview of Medicare Secondary Payer evolution from 1965 to today. It also includes an overview of workers' compensation. What is Workers' Compensation The Benefits in Workers' Compensation How Medicare is Impacted PPD, TTD, Defenses Differences in State Systems

     

    MEDICARE SECONDARY PAYER ACT

    This section will discuss the framework for the Medicare Secondary Payer Act. There will be a review of regulations and amendments. MSP Regulations and Amendments Future Medicare Payments vs. Past (Conditional Payments) Potential Consequences of non compliance - Future vs. Past Legal Update

    SPECIALTY CLAIMS

    This section will discuss the intricacies of specialty claims and the MSP Act. Longshore and Harbor Workers' Compensation Act FELA Claims Railroad Claims

    DISCUSSION OF CMS MEMOS

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

    CMS STRUCTURE

    An overview of who the entities/players (acronyms) are and how they function. Role of Attorney Role of the Allocator Role of the Carrier Structured Settlement Broker Medicare and Social Security Administration CMS CMS RO CMS Central Office MSP Central Office WCRC - JV MSPRC COBC

    STRUCTURED SETTLEMENTS AND CASE RESOLUTIONS  | MASA, SNTA, QSF

    This area of discussion includes case settlements and case resolution's impact on the Medicare Secondary Payer. Annuities and Structures Special Needs Trust MSA Funding - Lump Sum vs. Structure Role of Structure Settlement Consultant Various Structure Vehicles Calculation of the Initial and Annual Payment for a Structured MSA Arrangement Rated Age Life expectancy

    LIABILITY CLAIMS | HOW ARE THEY DIFFERENT FROM WC?

    This area of discussion includes case settlements and case resolution's impact on the Medicare Secondary Payer.
  • DAY TWO | TUESDAY

    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-ASIDE ALLOCATIONS COSTING AND CODING

    This section will discuss the details of costing and coding.

    DISCUSSION OF CMS MEMOS

    This section will discuss the intricacies of specialty claims and the MSP Act. Longshore and Harbor Workers' Compensation Act FELA Claims Railroad Claims

    DISCUSSION OF CMS MEMOS

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

    SECTION 111 READING

    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

    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.
  • DAY THREE | WEDNESDAY

    COURSE REVIEW

    Exam | Adjourn @ noon

     

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