Medicare Secondary Payer Act - Protecting Medicare's Interest in Insurance Settlements



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CD & Reference Manual
2 CD Set with bound 24 page manual
Copyright 2009
Self study credit available
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Overview
Pursuant to 42 USC Section 1395y(b)(2), commonly known as the Medicare Secondary Payer Act, Medicare may not make payment for medical benefits where “payment has been made or can reasonably be expected to be made under a workmen’s compensation law or plan of the United States or a state or under an automobile or liability insurance policy or plan (including a self-insured plan) or under no fault insurance.” By law, Medicare has a priority right of recovery from the primary payer as well as from parties in receipt of third-party payments, such as a beneficiary, provider, supplier, physician, attorney, state agency or private insurer (42 CFR 411.24(g)). Accordingly, it is essential that all parties to personal injury insurance settlements ensure that Medicare’s interests are protected and therefore of the utmost importance for all attorneys, insurance company personnel and medical billing professionals to fully understand how and when the MSP applies in any given personal injury situation. You will benefit from an overview of all pertinent statutes and regulations, as well as CMS interpretation in its manuals and policies. We’ll address individual areas of law separately as to the manner in which the MSP applies in each. Most significantly, you’ll learn about workers’ compensation settlements, as CMS is most actively monitoring them and has established policies with respect to addressing past and future medical expenses in the settlement of claims. We’ll address liability settlements as a hot topic since there is no established CMS guidance as there is in workers’ compensation, yet it’s rumored to be CMS’ next target. You’ll walk away with valuable insight and a better understanding of Medicare’s role in insurance claims settlement.

Authors
Jennifer C. Jordan, Medval, LLC

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