NuQuest Bridge Pointe

This presentation addresses the major aspects of the WC-MSA process. Emphasis is placed on understanding CMS’ WC-MSA “review thresholds’ and non-threshold considerations from a practical standpoint. The various options and considerations regarding MSA funding and administration are also examined.

This presentation focuses on the interesting and complex topic of protecting Medicare’s interests in “non-threshold” WC cases. CMS has stated that its WC-MSA “review thresholds” are NOT safe harbors and that parties need to consider Medicare’s interests in all cases. However, CMS has not provided any further guidance on this point. This module addresses the various issues and considerations that primary payers and practitioners need to understand to navigate this complex area and avoid potential exposure.

CMS’ new RX drug policies for WC-MSAs continue to present considerable challenges and problems for the claims industry. In many instances, these new policies are resulting in large increases to the MSA amount and making claims more difficult to settle. This presentation examines CMS’ RX policies and the various issues raised by the agency’s current approaches to calculating the RX drug allocation amount. In addition, the presentation explores several practical considerations for claims handling and settlement practices to confront this new challenge.

This presentation takes an in-depth look at the issue of MSA Administration – an aspect of the MSA process that is far too often overlooked. The presentation focuses on CMS’ several and detailed requirements for self-administered MSA accounts. The various issues, considerations and potential areas of exposure regarding self-administered accounts are examined from a practical standpoint. In addition, the presentation explores several practical options that are available to help meet the challenges and minimize potential exposure.

This presentation addresses primary payer obligations regarding Medicare conditional payments. Special focus is placed on understanding the statutory obligations, including why Medicare has a right to seek reimbursement even in the denied/disputed cases; the stringent conditional payment recovery formula and its potential impact on case settlement and practical measures to address the issue. In addition, CMS’ new procedures and policies to obtain conditional payment information and dealing with the MSRPC will be outlined.

This presentation provides updated information and explains all major aspects of Medicare’s new “notice and reporting” law – Section 111 of the MMSEA, including:

•    Who Must Report? – RRE Determination
•    Determining Medicare Status – Query Function & Model Language
•    When Must I Report? – Understanding the TPOC & ORM Reporting “Triggers”
•    How Does it All Work? – Reporting Mechanics

There continue to be major developments affecting primary payer obligations under the Medicare Secondary Payer Statute (MSP).

CMS continues to implement its new “notice and reporting” requirements per Section 111 of the MMSEA, with several key questions remaining core aspects of the agency’s MIR program. Regarding conditional payments, the recent case decisions of Harris, Hadden, Bradley, and Stricker address several key aspects of the conditional payment reimbursement process. On the MSA front, CMS’ new RX policies continue to present a number of challenges to practical claims handling and settlement practices.

It is imperative that the impact of these changes (and the possible impact of proposed MSP amendments) be properly understood to ensure proper compliance under the MSP. This presentation places these new developments into proper focus to assist primary payers address the changing MSP landscape.

As demonstrated by MMSEA Section 111 reporting and recent litigation, Medicare continues to tighten its grip on the claims industry to ensure that its interests are properly protected under the Medicare Secondary Payer Statute (MSP). Now more than ever, liability claims are on Medicare’s radar. Two formidable compliance challenges currently facing liability primary payers and practitioners include: Liability MSAs and Conditional Payments.

Regarding the liability MSA, this issue has been, and continues to be, complicated and confusing. CMS’ lack of written guidance, the agency’s confusing oral proclamations, along with industry practices have all combined to create a complex playing field for primary payers and practitioners. With respect to conditional payments, Medicare has strong and broad enforcement rights to pursue any number of parties in liability cases, including the right to pursue “double damages” against primary payers.

This presentation examines all pertinent issues concerning liability claims in relation to MSP compliance. The topics discussed include:

The Liability Medicare Set Aside

•    What Exactly Are the Issues?
•    How Does the MSA Process Work? -- MSA Nuts & Bolts
•    Practical Considerations
      •  Current State of Affairs
      •  Analyzing CMS Statements
      •  Practical Steps to Address the Issue
      •  Impact on Claims Handling & Settlement Values
      •  Bigger Picture Issues & Considerations

Medicare Conditional Payments

•    What are Medicare conditional payments?
•    Why “pinning” responsibility on the plaintiff may not be enough
•    Recent Court Decisions – Impact of recent decisions on claims handling practices
•    Addressing the issue practically to avoid “double damages”

Properly considering and protecting Medicare’s interests involves building claims and settlement protocols that address the various aspects of MSP compliance. Developing and instituting MSP best practices and compliance requires not only an understanding of statutory obligations and CMS policies, but how same relate to every day claim practices.

This presentation identifies and examines the practical claims handling considerations necessary to address the following core MSP compliance aspects:

•    Developing Workflows and processes regarding:
      •  Determining Medicare and Social Security Status
      •  Medicare conditional payments
      •  Medicare Set-Asides
      •  MSA and Medical Custodial Account Administration
•    How NuQuest/Bridge Pointe Can Help

With MMSEA Section 111 reporting having finally started for certain claims, primary payers and practitioners need to ensure that they have a complete understanding of ALL their Medicare compliance obligations: Section 111, Conditional Payments & the MSA.

This presentation goes beyond mere theory and examines just how all the moving parts of Medicare Secondary Payer (MSP) compliance actually work through every day case fact patterns and examples to make sure that your protocols and practices are addressing all key MSP compliance issues and considerations.

This presentation will help “spot and synthesize” important MSP issues from a practical claims handling perspective, including the following:

•    Determining Medicare & Social Security Status
      --  CMS’ Query Function System: Its Role & Limitations
•    Do I Have a TPOC? Do I Have an ORM? What Does it Mean and NOT Mean?
•    My Case Does Not Need to Be Reported Yet – Am I Done?
•    CMS’ WC-MSA Review Thresholds --- Avoiding the Pitfalls
•    Section 111 vs. COBC Reporting --- What is the Difference, Why Does it Matter?
•    Medicare Conditional Payments – Avoiding Double Damages
•    Fine Tuning Your Best Practices and Protocols
•    How NuQuest/Bridge Pointe Can Help