At the 2016 IAIABC Annual Convention, Becky Curtis, founder of Take Courage Counseling, talked about how the workers’ compensation system can enhance the experience of injured workers. Years ago, Becky suffered a horrible automobile accident that resulted in a fractured spine and left her as an incomplete quadriplegic. After the accident, she spent most of the first year in a wheelchair while undergoing extensive rehabilitation. She had to learn to walk again and perform activities of daily living. She was eventually pronounced at maximum medical improvement and discharged from care as her condition stabilized.  Chronic pain was part of her
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This week Conference Chronicles is attending the IAIABC Annual Convention in Portland, ME. IAIABC is an association of workers’ compensation regulators from around the United States.  The theme this years convention is “reimagine” and the program tried to highlight innovations and disruptionis that will shape the system in the future. You can learn more about their event HERE

At the 2016 NAMSAP Annual Conference, a panel provided an overview of how CMS is handling liability Medicare set-aside arrangements. The panel was: David Cherry – Cherry Injury Firm Roy Franco – Franco Signor, LLC Thomas Spratt – NuQuest There are significant differences between workers’ compensation and liability Medicare set-asides. Workers’ compensation benefits are statutory and often includes potential exposure for lifetime medical treatment. Liability coverage can be mitigated by contributory negligence, and it is ultimately subject to the policy limits. Another challenge in the liability allocation is the concept of equity; whether the claimant was “made whole” by the
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At the 2016 NAMSAP Annual Conference, a panel discussed pricing methodologies for Medicare Set Asides. The panel was Beth Hostetler – Safeway Albertson’s Christine Melancon – EZ-MSA Services Jake Reason – EK Health Services CMS looks for trends in the treatment in making allocating recommendations. Many regions want to see 4 doctors visits on the topic. On durable medical equipment, CMS wants to see the actual bills to know the charges and they need documentation on the frequency of replacement. There is much debate over how they project future pharmacy costs and many argue they project things going forward at
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At the 2016 NAMSAP Annual Conference Monika Boswein from Acuity and Katie Fox from Franco Signor LLC discussed issues around conditional payments and safe harbor provisions in the SMART Act. When you are considering potential penalties and compliance issues one thing to keep in mind is that safe harbor’s are triggered by reporting. If you do not report the claim to CMS then the safe harbor protections provided in the SMART Act do not apply. Also, while the Statutes do allow for financial penalties for late reporting (the dreaded $5000 per day penalty) CMS has never pursued penalties for late
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At the 2016 NAMSAP Annual Conference a panel discussed cases around the country on the reimbursement rights of private entities. The panel was: Ciara Kobe – Burns White Heather Sanderson – Franco Signor, LLC Jennifer Jordan – MEDVAL Lee Yeakel – Judge US District Court, Western District Texas Medicare Advantage plans are private healthcare plans that are funded by Medicare to provide benefits to Medicare beneficiaries. While they are private entities, their funding comes from Medicare. CMS is pushing Medicare Advantage providers to assert their reimbursement rights in secondary payer actions in an effort to control costs. When Medicare Advantage
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The speakers for this 2016 WCI conference session included: Nat Levine, Independent Medical Practice Consultant Marcos A. Iglesias, MD, MMM, FAAFP, FACOEM, Vice President and National Medical Director, The Hartford Fire Insurance Company In addition to the ever-increasing costs of opioid drug therapy, research shows a link between the therapy and a longer duration of the claimant’s disability. One study showed that claimants were disabled longer with the therapy than without it. Dr. Iglesias discussed the connections and solutions to opioids and disability. He opened the discussion with some opioid statistics in the U.S.: There were 259 million prescriptions for
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Advocacy is one of the most talked about concepts within the industry and holds the potential for redefining the claims process as we know it today. This session at WCI’s 2016 Annual Workers’ Compensation Educational Conference explored advocacy from a range of perspectives to show how such an approach can benefit virtually any claims program. Speakers included: Tara Acton, Director Claims and Senior Corporate Counsel, CenturyLink Artemis Emslie, CEO, myMatrixx Kimberly George, Senior Vice President, Corporate Development, M&A, and Healthcare, Sedgwick Dr. Maja Jurisic, Vice President, Medical Director, Concentra Advocacy puts the injured worker at the center of the claims
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Workers’ compensation is one of the most highly-regulated lines of insurance. This session at WCI’s 2016 Workers’ Compensation Educational Conference reviewed how these state variations are impacting employers today and some of the solutions being considered to reduce this seemingly excessive bureaucracy plaguing the system. Speakers included: Todd Brown, Practice Leader Compliance and Regulatory, Medata Francine Johnson, Senior Director of State Programs and Product Strategy, FairHealth Jon Wroten, Senior Vice President, Regulatory Compliance Quality, Sedgwick Mark Walls, Vice President – Communications and Strategic Analysis, Safety National The Problems Statutory requirements vary across all 50 states are causing payers added expense
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Talent attraction, retention and training are among the industry’s most promising opportunities and an influx of new professionals is paramount to the long-term success of our business. In this session at WCI’s 2016 Workers’ Compensation Educational Conference, executive leaders in the industry shared their perspectives on what they believe will be the necessary skill sets to fill this growing talent gap and what they are doing to recruit and train new hires to fill this need. Speakers included: David A. North, President and CEO, Sedgwick Mark Wilhelm, CEO, Safety National Peter Miller, President and CEO, The Institutes Danielle Lisenbey, President
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