"When Credibility is Critical"
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MEDICARE SET-ASIDE (MSA) ARRANGEMENTS & ALLOCATIONS: LIABILITY INSURERS/PERSONAL INJURY
Impact of Section III of the Medicare, Medicaid, & SCHIP Extension Act of 2007 (MMSEA)
Medical Insurance Reporting (MIR):
- Gives immediate attention to conditional payment reimbursement
- WC, liability (including self-insurance), and no-fault insurance
- Identify Medicare claimants
- $1,000.00/day noncompliance penalty
- Responsible reporting entities (RRE): liability insurers, self-insurers, no-fault insurers, joint pools, and state-assigned funds (TPA Only if self-insures WC and liability)
Consider . . .
Developing a process by which Medicare's future interest is considered:
- Identify Medicare beneficiary cases
- Report cases to coordinator of benefits contractor (COBC)
- Obtain conditional payment information
- Resolve/reimburse conditional payment claims
- Develop internal policies regarding settlements that fall outside CMS' review thresholds (workload thresholds)
Consider an MSA that is:
- Limited to a projection of future medical care related to claim otherwise covered by Medicare
- Make individual decisions regarding submission (some regulatory officers are choosing to review)
- Specify that future medical funds are identified in settlement
- Ensure that conditional payments are addressed
- Resolve/reimburse conditional payment claims
This page was last updated: March 6, 2012
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