Medicare Secondary Payer Act - Protecting Medicare's Interest In Insurance Settlements
2/15/2010
Pursuant to 42 USC Section 1395y(b)(2), commonly known as the Medicare Secondary Payer Act, Medicare may not make payment for medical benefits where 'payment has been made or can reasonably be expected to be made under a workmen's compensation law or plan of the United States or a state or under an automobile or liability insurance policy or plan (including a self-insured plan) or under no fault insurance.'
By law, Medicare has a priority right of recovery from the primary payer as well as from parties in receipt of third-party payments, such as a beneficiary, provider, supplier, physician, attorney, state agency or private insurer (42 CFR 411.24(g)).
We will cover:- An overview of all pertinent statutes and regulations
- CMS interpretation in its manuals and policies
- Individual areas of law separately as to the manner in which the MSP applies in each
- About workers' compensation settlements as CMS is most actively monitoring them and has established policies with respect to addressing past and future medical expenses in the settlement of claims
- Liability settlements as a hot topic since there is no established CMS guidance as there is in workers' compensation
- yet it's rumored to be CMS' next target
You'll walk away with valuable insight and a better understanding of Medicare's role in insurance claims settlement.
Agenda- Medicare as Secondary Payer
- The Law
- The Regulations
- The Policy
- Medicare Liens ? The Past
- Conditional Payments
- Repayment Required by Statute
- Compromise of Conditional Payments
- Coordination of Benefits Contractor
- Medicare Secondary Payer Recovery Contractor
- Medicare Set-Aside Allocations ? The Future
- When Must Medicare Be Protected in a Settlement?
- Calculating a MSA
- CMS Procedures for Workers' Compensation Settlements
- MSAs in Liability Settlements
- Annuities ? A CMS-Approved Method of Funding MSAs at Present Value
- Post-Settlement MSA Administration
- Medicaid, and Other State and Federal Benefits Eligibility
- Ethical and Legal Considerations for Attorneys
- Legislative Activities
- Settlement Tips
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