Presenting a 90-Minute Encore Presentation of the Webinar with Live, Interactive Q&A Medicare in Personal Injury Claim Settlements: Complying With Reporting Requirements and Satisfying Liens TUESDAY, MAY 17, 2016 1pm Eastern | 12pm Central | 11am Mountain | 10am Pacific 1pm Eastern | 12pm Central | 11am Mountain | 10am Pacific Today’s faculty features: Jeremy T . Burton, Partner , Lipe Lyons Murphy Nahrstadt & Pontikis , Chicago The audio portion of the conference may be accessed via the telephone or by using your computer's speakers. Please refer to the instructions emailed to registrants for additional information. If you have any questions, please contact Customer Service at 1-800-926-7926 ext. 10 .
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Jeremy Burton Lipe Lyons Murphy Nahrstadt & Pontikis Ltd. 230 West Monroe Street, Suite 2260 Chicago, IL 606006 (312) 448-6231 jtb@lipelyons.com
Trial and Settlement Considerations Introduction Introduction Considerations for Plaintiff’s counsel Considerations for Plaintiff’s counsel Considerations for Defense counsel Considerations for Defense counsel Settlement language Settlement language Negotiating Settlement with the CMS Negotiating Settlement with the CMS 6
Introduction Medicare is a government program providing health care. Medicare is a government program providing health care. Under Medicare, the government reimburses health care Under Medicare, the government reimburses health care providers for covered care provided. providers for covered care provided. Until 1980, Medicare was the primary payer of all medical Until 1980, Medicare was the primary payer of all medical costs except in workers’ compensation cases. costs except in workers’ compensation cases. After 1980, Medicare is always a secondary payer to liability After 1980, Medicare is always a secondary payer to liability insurance, self-insurance, no-fault insurance, and workers’ insurance, self-insurance, no-fault insurance, and workers’ compensation insurance. Medicare is also a secondary payer compensation insurance. Medicare is also a secondary payer to group health plan coverage in certain situations. to group health plan coverage in certain situations. 7
Introduction Insurers are not allowed to Insurers are not allowed to write policies secondary to write policies secondary to Medicare. Medicare. Such policies Such policies would would supersede supersede federal federal law. law. 8
Introduction Since 1980, Medicare beneficiaries, attorneys, insurers, Since 1980, Medicare beneficiaries, attorneys, insurers, self-insured entities, third party administrators and their self-insured entities, third party administrators and their agents have been responsible for agents have been responsible for Understanding when there is coverage primary to Understanding when there is coverage primary to (1) (1) Medicare, Medicare, (2) Notifying Medicare when applicable, (2) Notifying Medicare when applicable, (3) Paying appropriately. (3) Paying appropriately. 9
Introduction The new law, Section 111 of the Medicare, Medicaid and The new law, Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA Section) SCHIP Extension Act of 2007 (MMSEA Section) “Adds mandatory reporting requirements with respect to “Adds mandatory reporting requirements with respect to Medicare beneficiaries who have coverage under group Medicare beneficiaries who have coverage under group health plan arrangements as well as for Medicare health plan arrangements as well as for Medicare beneficiaries beneficiaries who who receive receive settlements, settlements, judgments, judgments, awards or other payment from liability insurance, no- awards or other payment from liability insurance, no- fault insurance, or workers’ compensation.” fault insurance, or workers’ compensation.” 10
Introduction Implementation dates for the new law were originally January Implementation dates for the new law were originally January 1, 2009 for group health plans to register and July 1, 2009 for 1, 2009 for group health plans to register and July 1, 2009 for liability insurers to register. liability insurers to register. Insurers must report claims with settlement dates on or after Insurers must report claims with settlement dates on or after October 1, 2011. * October 1, 2011. * In certain cases where an insurer has ongoing responsibility In certain cases where an insurer has ongoing responsibility for medical claims, claims arising after January 1, 2010 must for medical claims, claims arising after January 1, 2010 must be reported. be reported. 11
Introduction * Reporting Thresholds * Reporting Thresholds January 1, 2012 January 1, 2012 >$100,000 >$100,000 July 1, 2012 >$50,000 October 1, 2012 >$25,000 January 1, 2013 >$5,000 January 1, 2014 >$2,000 January 1, 2015 >$1,000 Not repayment thresholds Not repayment thresholds 12
Introduction The new law is designed to enforce the statutes passed in The new law is designed to enforce the statutes passed in 1980. 1980. It does not substantively change the pre-existing It does not substantively change the pre-existing Medicare law and statutes. Medicare law and statutes. It adds new reporting rules. It adds new reporting rules. It includes penalties for noncompliance. It includes penalties for noncompliance. 13
Considerations for Plaintiff’s Counsel Intake Considerations Intake Considerations Is the client 65 or older? Is the client 65 or older? Receiving Social Security Disability? Receiving Social Security Disability? Suffering from end-stage renal disease? Suffering from end-stage renal disease? Obtain your client’s Medicare identification card Obtain your client’s Medicare identification card Advise Defense counsel Advise Defense counsel 14
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