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THE 2ND ANNUAL

Medicare Secondary Payer Conditional Payment Forum Optimizing Compliance for Liability, No-Fault and Worker's Comp Payers June 19-20, 2018 | Sherat on Pentagon City Hot el | Arlingt on, VA Plus, an all-new, optional pre-conference workshop: Optimizing Mandatory Reporting Resolving conditional payments continues to be difficult and expensive while the risk of private cause of action from Medicare Advantage and prescription drug plans increases. Minimizing your regulatory and legal exposure is critical to your business. Strengthen your organization’s MSP compliance and Conditional Payment resolutions with best practices and updates on: • Navigating the Commercial Repayment Center (CRC) process • Resolving claims with the Benefits Coordination Recovery Center (BCRC) • New case law updates defining details of recovery rights and double damages • Medicaid Secondary Payer & Third-Party Liability

To register, call (704) 341-2393 or visit https:/events.healthcare-conferences.com/h554 V3 DW 5.16.18


Dear potential attendee: It is with great enthusiasm that I personally invite you and your colleagues to attend our Medicare Secondary Payer Conditional Payment Forum, June 19-20, 2018 at The Sheraton Pentagon City Hotel in Arlington, VA. This one of a kind, national in scope, comprehensive learning event has been put together with you in mind- the auto, liability, no-fault, and work comp insurance, claims, and legal professionals responsible for resolving your entity’s Medicare conditional payments. As all primary payers can attest to, resolution of conditional payments has become significantly tougher, more time consuming, extremely confusing, and incredibly more expensive. With increasing risk of private cause of action from Medicare advantage plans and prescription drug plans, as well as potential double damages sought by claimant/estate, medical providers, and assignees, resolution of conditional payments is paramount to overall Medicare secondary payer compliance program. The Medicare Secondary Payer Conditional Payment Forum is designed to address all of your substantive and technical questions on resolution of conditional payments, including: • Mandatory Reporting of ORM/ICD-10/TPOC • Navigating the Commercial Recovery Center Process • Resolving Payments with the Benefits Coordination Recovery Center • Medicaid Secondary Payer and Third Party Liability Liens • MSP Private Causes of Action for Double Damages from MAPs, Providers, Claimants We have brought together the most knowledgeable, experienced, and respected MSP faculty you will find anywhere in the country to speak about conditional payment issues that continue to challenge all employers, corporations, insurers, and third party administrators as they process and plan for settlement of their auto, no-fault, liability, and work comp claims. Hope you can join us in DC! Register today! Call 866.676.7689 or online at www.healthcare-conferences.com. Rafael Gonzalez, Esq., President FLAGSHIP SERVICES GROUP, LLC Conference Chairperson


W HO W IL L AT T END : This conference is designed for mid- to senior level management professionals responsible for Medicare Secondary Payer compliance for workers’ compensation, liability and no-fault insurance, self-insured companies, and third-party administrators with roles in: • Claims • Compliance • Legal • Risk Management • Finance • Medical Management


DAY ONE: Tuesday, June 19, 2018 7:00 – 8:00

Optional Pre-Conference Registration & Networking Breakfast

8:00 – 12:00

Optional Pre-Conference Workshop: Optimizing Mandatory Reporting Offering invaluable technical details and guidance on Medicare Mandatory Reporting, workshop leaders will teach you how and when to report and terminate Ongoing Responsibility for Medical (ORM), and the significance of reporting the correct ICD-9 or ICD-10. Workshop participants will learn how to ensure the accuracy of Total Payment Obligation to Claimant (TPOC) reporting and why it is crucial. All with an emphasis on its effect on the conditional payment resolution process for auto, liability, no-fault, and work comp claims.

8:00 – 9:00

Querying Under Section 111 Mandatory Insurer Reporting (MIR) • Reporting responsibilities for auto, liability, no-fault, and work comp plans • How and When to Query for Medicare Beneficiary Status • Does an RRE Need to Continue to Query Throughout Life of Claim Suzanne Jordan, SCHIP Compliance Manager BROADSPIRE

9:00 – 10:00

Reporting Ongoing Responsibility for Medical (ORM) • What is ORM, How and Where does an RRE Find ORM • How does an RRE Report ORM; What Triggers Reporting ORM • When and how can an RRE terminate ORM? Scott Huber, Senior Vice President, Technology EXAMWORKS


10:00 – 10:15

Morning Networking Break

10:15 – 11:00

Reporting International Classification of Disease Codes (ICD) • How to obtain the correct diagnosis code for the right injury • What do I report, ICD-9 or ICD-10 or both? • When and how can I delete, amend, or add an ICD? Noel Rose, Senior Product Matnager & MMSEA Compliance YORK RISK SERVICES GROUP

11:00 – 12:00

Reporting Total Payment Obligation to Claimant (TPOC) • What is TPOC, where does TPOC come from • When and how does an RRE report TPOC • What happens when RRE reports TPOC Frank Fairchok, Vice President of Medicare Compliance Reporting & Development OPTUM


12:00 – 1:00

Conference Registration & Networking Luncheon

1:00 – 1:15

Chairperson’s Welcome and Opening Address Rafael Gonzalez, Esq., President and Chief Legal Counsel FLAGSHIP SERVICES GROUP, LLC

1:15 –2:15

Keynote Address: MSP Issues and the 2018 Midterm Election • Will midterm elections affect Medicare Secondary Payer Act issues and payers? • Any news on the Workers Compensation Medicare Set Aside Settlement Agreement Act? • Any changes to the Secondary Payer Advancement, Rationalization, and Clarification Act? • How will the Provide Accurate Information Directly Act affect payers? Jay Keese, Principal and CEO CAPITOL ADVOCATES LLC Doug Holmes, President, UWC NATIONAL ASSOCIATION FOR UC AND WC

2:15 – 3:15

Navigating the Commercial Repayment Center (CRC) Process • What are the responsibilities of a primary payer identified by the CRC as the debtor? • How to appropriately and timely respond to CRC’s Conditional Payment Notice • Got CRC’s Final Demand/Determination. Now what? • Walking thru the appeal options - from redetermination to federal court • Ooops, my bad! Options when the debt has been referred to US Treasury • Is there ever real closure on open no-fault and lifetime work comp claims? Gina Cox, Vice President of Operations FLAGSHIP SERVICES GROUP


3:15 – 3:30

Afternoon Networking Break

3:30 – 4:30

Resolving Claims with the Benefits Coordination Recovery Center (BCRC) • A settlement, judgment, award, or payment is the triggering event • Obtaining the appropriate authorization from the claimant to resolve the debt • Setting up internal handling procedures for conditional payment letters (CPL) • It is all about the medical codes, so better stay on top of those ICD-9 and ICD-10 codes • Don’t forget to terminate ORM as part of your post settlement closure process Lavonya Chapman, RN, Esq., MSP Compliance Counsel OPTUM

4:30 – 5:30

Options to Best Handle CRC and BCRC Claims from the Payer’s Perspective • Hiring a vendor to take care of and manage the payer’s MSP responsibilities • Allowing the claims adjuster to handle and negotiate resolution of conditional payments • Building an internal dedicated team to deal with all CRC and BCRC issues • Letting the lawyers handle it: Handing it off to in-house counsel or outside law firm G. Cox FLAGSHIP L. Chapman OPTUM Christina White, Senior Counsel CITY OF NEW YORK Beth Nedow, Counsel CITY OF NEW YORK

5:30 – 6:30

Networking Reception


DAY TWO: Wednesday, June 20, 2018 8:00 – 9:00

Networking Breakfast

8:45 – 9:00

Chairperson’s Recap of Day One Rafael Gonzalez, Esq., President and Chief Legal Counsel FLAGSHIP SERVICES GROUP, LLC

9:00 – 10:00

Do MAPs and PDPs Have the Same Recovery Rights as Medicare? • Humana Medical Plan and Humana Insurance Company v. GlaxoSmithKline, LLC. • Private cause of action for double damages pursuant to 42 USC 1395y(b)(3)(A) • Do MAPs and PDPs enjoy the same rights as HHS pursuant to 42 CFR 422.108? • Proving a primary payer failed to reimburse a secondary payer in liability, nofault, and work comp claims Michael Abate, Esq., Partner KAPLAN, JOHNSON, ABATE & BIRD, LLP

10:00 – 11:00

Are MAP and PDP Assignees Also Allowed Double Damages? • MSP Recovery, LLC v. Allstate Insurance Company et al • Who are these assignees? Who is assigning them right to reimbursement? Why? • Even though there is no settlement, judgment, award, or payment, can they still come after me on MSP private cause of action for double damages? • Can contractual obligation be enough to show demonstrated responsibility? • Does this apply only to entities that have accepted ORM (no-fault and work comp)? Rachel LaMontagne, Esq., Partner SHUTTS & BOWEN


11:00 – 11:15

Morning Break

11:15 – 12:15

Other than MAPs and PDPs, What Other Entities Have Such Recovery Rights? • Michigan Spine and Brain Surgeons, LLC v. State Farm Mutual Automobile Ins. Comp. • Text of the MSP Act is unclear – is a private cause of action allowed against NGH plan? • Are medical providers allowed to use MSP private cause of action to recover funds? • What is necessary to prove responsibility of conditional payments by primary payer? April Ross, Esq., Partner CROWELL MORING

12:15 – 1:15

Lunch for All Conference Participants

1:15 – 2:15

Here Come the Claimants! Do Beneficiaries Also Have Recovery Rights Too? • Estate of Clinton McDonald v. Indemnity Insurance Company of North America • Hull v. Home Depot • Are beneficiaries/estate allowed to use MSP private cause of action to recover funds? • What does beneficiary/estate need to prove in order to collect double damages? Rafael Gonzalez, Esq., President and Chief Legal Counsel FLAGSHIP SERVICES GROUP, LLC


2:15 – 3:15

But Wait, There’s More! Medicaid Secondary Payer & Third-Party Liability • State expansion status and Medicaid trends throughout the US • How is Affordable Healthcare Act Medicaid Expansion impacting primary payers? • The Medicaid Secondary Payer & Third Party Liability Act has been repealed. Now What? • Implementing action plans for future requirements Robert Finley, Esq., Partner HINSHAW & CULBERTSON, LLP

3:15 – 3:30

Afternoon Break

3:30 – 4:30

Best Practice Tips on MAP, Assignees, Providers, and Beneficiary Claims • Finding the Medicare Advantage and Prescription Drug Plan: Best practice tips • Considerations when responding to Assignee’s claim for reimbursement • What to look for to prevent medical providers from filing an MSP claim • Hints and clues to keep the claimant and his/her counsel from seeking double damages Moderator: Rafael Gonzalez, Esq., President and Chief Legal Counsel FLAGSHIP SERVICES GROUP, LLC Panelists: Michael Abate, Esq., Partner KAPLAN, JOHNSON, ABATE & BIRD, LLP April Ross, Esq., Partner CROWELL MORING Robert Finley, Esq., Partner HINSHAW & CULBERTSON, LLP

4:30

Conference Concludes


V ENUE Sheraton Pentagon City Hotel 900 S Orme St. Arlington, Virginia 22204 We have a block of rooms reserved at a special rate of $159/night. This rate expires on May 18th, 2018; although, we expect the block to sell out prior to this date. To receive a room at the negotiated rate book well before the expiration date. Mention “Medicare Secondary Payer Conditional Payment Forum” when placing your room reservation by phone to receive the negotiated rate. We urge you to book your room early as we expect the block will sell out. Upon sell out of the block room rate and availability will be at the hotel’s discretion. Please call 703.521.1900 to book your room.

T E A M DIS C OUN T S • Three people will receive 10% off. • Four people will receive 15% off. • Five people or more will receive 20% off. In order to secure a group discount, all delegates must place their registrations at the same time. Group discounts cannot be issued retroactively. For more information, please contact Whitney Betts at (704) 341-2445 or wbetts@healthcare-conferences.com. Refunds and Cancellations For information regarding refund, complaint and/or program cancellation policies, please visit our website: www.frallc.com/thefineprint.aspx


T HE C ONFER ENC E OR G A NI Z ER

RISE (Resource Initiative & Society for Education) Vision: To build a community and an educational system that promotes successful careers for professionals who aim to advance the quality, cost and availability of health care. RISE provides: • A forum to build professional identity and a network of colleagues • A platform to capture and share knowledge and insights • A venue to develop and share benchmarks and document best practices • Career track development support • A channel for building alliances, partnerships, and affiliations that fulfill the vision RISE (Resource Initiative & Society for Education) Mission: RISE is the first national association totally dedicated to enabling healthcare professionals working in organizations and aspiring to meet the challenges of the emerging landscape of accountable care and health care reform. We strive to serve our members on four fronts: Education, Industry Intelligence, Networking and Career Development. To learn more about RISE and to join, visit us online: www.risehealth.org

PR IC ING Early Bird ends 4/27/18

Standard Rate

Conference

Conference +

Conference

Conference +

Only

Workshop

Only

Workshop

Non-Group Health Plans*

$795

$1,095

$895

$1,195

Vendors and Consultants

$1,495

$1,795

$1,595

$1,895


T HR EE WAY S T O R EGIS T ER Call

866-676-7689

Web

events.healthcare-conferences.com/h554

Mail

Wilmington FRA

REGISTER

3420 Toringdon Way, Suite 240 Charlotte, NC 28277 Make checks payable to Wilmington FRA and write H554 on your check.

SP ON S OR SHIP A ND E X HIBI T OPP OR T UNI T IE S Enhance your marketing efforts through sponsoring a special event or exhibiting your product at this event. We can design custom sponsorship packages tailored to your marketing needs, such as a cocktail reception or a custom-designed networking event. To learn more about sponsorship opportunities, please contact Michelle Elam at 704.341.2393 or MElam@healthcare-conferences.com

The 2nd Annual Medicare Secondary Payer Conditional Payment Forum  

Optimizing Compliance for Liability, No-Fault and Worker's Comp Payers

The 2nd Annual Medicare Secondary Payer Conditional Payment Forum  

Optimizing Compliance for Liability, No-Fault and Worker's Comp Payers