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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The keynote speakers for Breakout for Agents at the 2016 WCI Conference were Mark Walls, Vice President Communications & Strategic Analysis at Safety National and Kimberly George, Senior Vice President, Corporate Development, M&A and Healthcare at Sedgwick. They discussed the state of the workers’ compensation marketplace and significant issues impacting workers compensation.  State of the market – For the first time since NCCI started tracking industry combined ratios, workers’ compensation has been profitable for three consecutive years. This is due to the combination of better underwriting and increased rates over several years. Interest rates remain low so carriers are still challenged
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Startling statistics, trends and illustrations reveal an undeniable prescription drug problem in the United States. This session at WCI’s 2016 Workers’ Compensation Educational Conference focused on chronic pain management, including alternative and advanced treatment methods being used to alleviate pain and restore quality of life among those who have become ill or have been injured on the job. Speakers included: Dr. Teresa Bartlett, Senior Vice President, Medical Quality, Sedgwick Michael Gavin, CEO, Prium Dr. Eric Won, President, Brain Research Laboratory   Opioids and other powerful narcotics are often the first line of defense in addressing chronic pain among injured or
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“Comp Talks 2016” featured three women in risk management who discussed their formulas for success in developing and maintaining winning risk management programs. The speakers for this 2016 WCI session included: Moderator: Joe Picone, CPCU, AIC, Claim Consulting Practice Leader, Willis Towers Watson, Glen Allen, VA Panel: Michele Adams, Vice President, Risk Management Services, Walt Disney World Resort Tara L. Acton, Director – Claims & Senior Corporate Counsel, CenturyLink Marti Dickman, VP Risk Management, Advanced Disposal Michelle Adams presented “Creating an Award Winning Risk Management Program.” One of the things that distinguish their program at Disney is their understanding of
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