Medicare Secondary Payer Compliance

Andrew Sabolic
Executive Director
Workers’ Compensation Institute (WCI)

WCI 2022: Session Sneak Peak

The Medicare Secondary Payer (MSP) program continues to evolve, and its impact on claims-handling and reporting are far-reaching on the worker’s compensation industry. The sessions at this year’s conference showcase officials from Centers for Medicare & Medicaid Services (CMS) and private sector experts on MSP compliance, reporting, and claim outcomes.

Officials from CMS’s Division of Medicare Secondary Payer Operations kick-off the sessions by providing the latest information on the MSP program and key policy changes. The Division oversees all aspects of MSP compliance, including Section 111 Mandatory Insurer Reporting, Medicare conditional payment recovery and workers’ compensation Medicare Set-Aside review and approval. CMS has or soon will release final regulations around Section 111 Reporting penalties. These penalties, which can be up to $1,000 per day, per claim, are significant. This session’s panelists will describe best practices to avoid such penalties. The CMS January 2022 policy statement which says the agency considers non-submit/evidence based MSAs “as a potential attempt to shift financial burden” to Medicare reignited the debate over submit vs. non-submit MSAs. Our experts will share their experience on the best course of action with settlements involving MSAs. The final sessions will be a deep-dive into the claims process where the use of data and artificial intelligence can be most beneficial from the initial stages of a claim through the future allocation of medical at settlement.

For a complete copy of this year’s conference program, please click here. The Medicare Secondary Payer Compliance breakout is summarized here.