Medicare: Primary Payer Compliance

MEDICARE: PRIMARY PAYER COMPLIANCE Prepared By: Carrie T. Taylor, J.D.

Medicare Entitlement ,[object Object],[object Object],[object Object],[object Object]

Medicare ,[object Object],[object Object],[object Object],[object Object],[object Object]

Medicare Secondary Payer (MSP) Statute ,[object Object],[object Object],[object Object]

Who is a primary payer? ,[object Object],[object Object],[object Object]

Compliance ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Future Consideration I. Medicare Set Aside

I. Medicare Set Aside (MSA) ,[object Object],[object Object],[object Object],[object Object]

Is an MSA necessary when settling a non-WC claim? ,[object Object],[object Object],[object Object]

Past Consideration II. Conditional Payment Reimbursement

MEDICARE AS SECONDARY PAYER ,[object Object]

Medicare As Secondary Payer ,[object Object],[object Object]

Historical Obligations ,[object Object]

Learns vs. Demonstrated ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Medicare’s Dilemma? How to determine compliance…

MMSEA Section 111 III. Notice/Reporting

Civil Money Penalties ,[object Object]

Medicare, Medicaid and SCHIP Extension Act ,[object Object],[object Object],[object Object],[object Object]

Section 111 Solves Medicare’s Dilemma ,[object Object],[object Object]

Who Must Report? Responsible Reporting Entity (RRE) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

RRE Problem Areas ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

RRE Registration: 5 Steps ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

RRE Registration: 5 Steps ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

RRE Registration: 5 Steps ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

What will be reported to the COBC? ,[object Object],[object Object]

ORM Reporting Thresholds (Begin 7/1/2009) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

TPOC Reporting Thresholds (Begin 1/1/2010) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Section 111 Reporting ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Use of Agents ,[object Object],[object Object]

Top Ten Best Practices ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Medicare: Primary Payer Compliance

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