Top Three Medicare Issues Impacting Workers’ Compensation

This session at the 2016 California Workers’ Compensation & Risk Conference highlighted three major Medicare issues impacting workers’ compensation today. Speakers included: Dan Wynn, Workers’ Compensation Manager, Goodwill Southern California John Kane, Medicare Program Director, Liberty Mutual Ciara Koba, Partner, Burns White LLC Latest Developments The SMART Act amended the Social Security Act requiring that […]

Liability Medicare Set-Asides

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 […]

Adventures in Allocating

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 […]

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Safe Harbor Provisions in the SMART Act

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 […]

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Medicare Advantage Case Law

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 […]

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Medicaid: The next MSP Compliance challenge

At the 2016 RIMS Annual Conference, a panel presented a session highlighting the latest challenges in Medicare Secondary Payer Compliance. The panel was: John Burkholder – Director Risk Management, Broward County Board of County Commissioners Cliff Connor – Vice President Medicare Compliance, Gallagher Bassett Services Roy Franco – Chief Legal Officer, Franco Signor LLC The […]

What is a Formulary and How Does a State-Adopted Formulary Work For You?

At the 2015 California Coalition on Workers’ Compensation Annual Conference (CCWC), a panel discussed the pros and cons of a state-adopted pharmacy formulary. Panelists included Dr. Bernyce Peplowski and Alex Swedlow from CCWC and Brenda Wood and Karen Caterino from Healthcare Solutions. A workers’ compensation formulary is designed to be specific for industrial injuries and […]

Federal Intrusion into Workers’ Compensation

At the 2015 National Council of Self-Insurers Conference, Robert Minor from Vorys, Sater, Seymour & Pease presented a session discussing the federal government’s intrusion into state workers’ compensation issues. The first federal intrusion into workers’ compensation issues started with the Mine Safety Act in 1968. Shortly thereafter, in 1970, the federal government established OSHA to […]

Unraveling the Mysteries of Medicare Secondary Payer Compliance

At the 23rd Annual National Workers’ Compensation & Disability Conference on November 19-21, 2014, one of the sessions focused on the challenges faced in Medicare Secondary Compliance. The session titled “Workers’ Compensation and Its Secondary Payers: Medicare and Medicaid” featured Tim Nay of Nay & Friedenberg, Vernon Sumwalt of The Sumwalt Law Firm and Jennifer […]

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