Educational Programs

NuQuest/Bridge Pointe offers cutting edge educational presentations that provide both the knowledge and tools necessary to comply with Medicare Secondary Payer Regulations.

Choose from our current offerings below or request a customized presentation to meet your individual needs. Presentations are available on-site or via live web based seminar and are approved for CEU credits in select states. Request an educational presentation.

Medicare Conditional Payments: Current Obligations and New Requirements under Section 111 of the MMSEA
As part of the settlement process, it is necessary to determine if the claimant is entitled to Medicare.  Under Section 111 of the Medicare, Medicaid & SCHIP Extension Act (MMSEA), a “responsible reporting entity” is required to report claims involving a Medicare beneficiary and provide Medicare with certain information per CMS’ Mandatory Insurer Reporting (MIR) guidelines; the penalty for non-compliance with Section 111 is steep:  $1,000 per day, per claim. 

In addition, if the claimant is a Medicare beneficiary it is necessary to thoroughly investigate whether Medicare has a claim for “conditional payments.” Under the Medicare Secondary Payer Statute (MSP), primary payers and other entities are required to reimburse Medicare for conditional payments. Failure to address the issue of conditional payment reimbursement can subject the primary payer to double damages, result in a loss of benefits for the injured individual, and subject other parties (including attorneys) to a potential action from CMS.

This presentation focuses on the current obligations of primary payers under the MSP and addresses the new “notice and reporting” requirements per Section 111 of the MMSEA and CMS’ MIR guidelines related thereto.

Protecting Medicare’s Interests in Cases Not Meeting the CMS Review Thresholds

The Centers for Medicare and Medicaid Services has reinforced that, under the Medicare Secondary Payer provisions, Medicare is always secondary to workers’ compensation and other insurance such as no-fault and liability insurance and that the current CMS review thresholds are CMS workload review thresholds only, not substantive dollar or “safe harbor” thresholds for complying with the Medicare Secondary Payer law. Therefore, Medicare’s interests must always be considered and protected when settling any workers’ compensation case; even if CMS review thresholds are not met.  This program outlines several practical approaches to considering and protecting Medicare’s interests in cases not meeting the CMS review thresholds.

Considering Medicare’s Interests in Liability Settlements: It is not just for workers’ compensation

When and how to consider Medicare’s interests in a liability settlement, judgment or award is a topic of significant discussion among liability carriers and attorneys. The code of Federal Regulations contains special rules for liability insurance settlements and there is significant exposure for carriers, claimants and attorneys if Medicare’s interests are not adequately considered. This presentation will review the statutory framework, discuss recent guidance provided by CMS staff, and offer practical approaches for considering Medicare’s interests in liability cases.

Medicare Set-Aside Account Administration

Many MSA arrangements are self-administered by injured individuals, however many claimants are not properly screened to determine if Professional Administration is required or given adequate information and resources to successfully self-administer.  Failure to properly administer a MSA account according to CMS guidelines could put a claimant's future Medicare benefits at risk.  This program outlines CMS' requirements regarding the administration of a MSA account, requirements for both professional and self administration, common problem areas and other considerations.

Medicare Set Aside Basics: Understanding the three components of an MSA arrangement

When a case requires a Medicare Set Aside (MSA) Arrangement, the primary focus tends to be on the MSA allocation amount. While the proposed MSA allocation amount is an important factor, equally important is the method of funding the MSA account and the method of administering the MSA account funds post settlement.  This presentation provides participants with a basic understanding of each of the three components of an MSA arrangement, the options available under each component and the potential pitfalls.

Settling WC Medical Expenses Prior to CMS Approval of a Proposed MSA

In the July 11, 2005 CMS policy memorandum, Question 5 addressed the settlement of Workers' Compensation medical expenses prior to CMS review of a proposed MSA.  While the memorandum focused on the provision of proof of full funding to CMS, this presentation addresses several other issues to be considered including repayment of Medicare conditional payments, responsibility for funding of additional amounts required by CMS and the potential for modification of the initial and annual payment amounts for MSA arrangements funded by a structure.

Developing Internal Protocols for Medicare Secondary Payer Compliance

Insurance Carriers and Third Party Administrators are becoming increasingly aware of the need to develop internal protocols for complying with the MSP provisions and to ensure those protocols are consistently adhered to. This program outlines the key components that should be considered when developing compliance protocols as well as practical approaches to implementation.

Presentations are approximately 1 hour in length