Rise

Welcome Remarks

Rafael Gonzalez, Esq., Partner
Cattie & Gonzalez, PLLC

Examine the Medicare Conditional Payment Process for Plaintiff Claims

• Review US statutory provisions to better comprehend how they impact Medicare conditional payments
• Examine the Code of Federal Regulations to avoid potential errors
• Analyze significant and trending case law to pinpoint common trends important to compliance
• Explore current CMS policy on the resolution of conditional payments in the various types of plaintiff claims at CRC and BCRC

Rafael Gonzalez, Esq., Partner

Cattie & Gonzalez, PLLC

If you’re interested in speaking, please contact Tim Hart at thart@risehealth.org

Assess the Claims Reporting Process to Medicare

• Understand the importance of early communication and reporting to Medicare
• Ensure accurate reporting of the date and description of accident, and the injuries associated through portal and other means
• Discuss the importance of continuously updating Medicare of the status of the medical conditions and ongoing care

Clayton W. Starnes, Esq., Founder,

PRESERVE Settlements, LLC

If you’re interested in speaking, please contact Tim Hart at thart@risehealth.org

Conditional Payments Resolution in Liability Claims

• Examine the conditional payment resolution process for auto accidents, personal injury, product liability, and medical malpractice claims at the BCRC
• Evaluate differences and similarities within processes for each
• Capitalize on best practices by obtaining a Conditional Payment Letter (CPL) from BCRC on a regular basis
• Discuss when to request for a final demand from BCRC to finalize resolution

Charles R. Medlin, COO & Founder,
LitPRO, LLC

Andrea Morton
Vice President, Operations
LitPRO, LLC

Conditional Payments Resolution in No-Fault Claims

• Identify if the no-fault insurance carrier has accepted ongoing responsibility for medical expenses (ORM)
• Analyze the process for plaintiff and lawyer if the carrier has accepted ORM within the confines of policy limits
• Ensure the carrier is reimbursing Medicare for conditional payments related to the claim
• Assess whether plaintiff and lawyer should communicate with CRC throughout claim

Ryan Weiner, Chief Operating Officer, 

MASSIVE Medical and Subrogation Specialists

(Invited)

If you’re interested in speaking, please contact Tim Hart at thart@risehealth.org

Conditional Payments Resolution in Workers Compensation Claims

• Assess if employer or workers compensation carrier accepted ORM
• Explore process for plaintiff and lawyer if ORM is accepted by employer or workers compensation carrier
• Analyze processes and communications if ORM is not accepted
• Discuss responsibilities of plaintiff and lawyer, including engaging with CRC to obtain information about conditional payments made on the claim

John V. Cattie, Jr., Managing Attorney,

Cattie & Gonzalez, PLLC

If you’re interested in speaking, please contact Tim Hart at thart@risehealth.org

Conditional Payment Appeals Process

• Explore the appeals process for liability, no-fault, and workers compensation claims to understand the similarities and differences between CRC and BCRC processes
• Examine the redetermination process for an appeal, including documentation and applicable timelines
• Discuss processes for reconsideration appeal to ensure all documentation required is prepared and submitted accurately and compliantly
• Prepare for a hearing before an ALJ with all appropriate documentation and arguments needed for success

Steven Shaw, Attorney & Certified Medicare Secondary Payer Professional,

Shaw Legal Solutions

(Invited)

If you’re interested in speaking, please contact Tim Hart at thart@risehealth.org

Closing Remarks

Rafael Gonzalez, Esq., Partner
Cattie & Gonzalez, PLLC

Conditional Payments Resolution in Mass Tort Claims

• Understand what a mass tort case consists of, and examine recent cases
• Analyze the process to prepare for lien resolution in a mass tort case, including which documentation needs to be prepared
• Examine the process of dealing with Medicare before and after mass tort case has been finalized, including global resolution of conditional payments

Sylvius von Saucken, Esq., Vice President, Strategy and Advisory Services,

Epiq

(Invited)

If you’re interested in speaking, please contact Tim Hart at thart@risehealth.org

Industry Leader Wrap Up for Plaintiff Conditional Payments

• Discuss key takeaways from today’s discussion that will improve efficiency within the conditional payment process
• Examine potential changes on the horizon related to conditional payment to be better prepared
• Evaluate best practices to prevent cases from being referred to the Department of Treasury and/or Department of Justice

Moderator

Rafael Gonzalez, Esq., Partner

Cattie & Gonzalez, PLLC

Panelists

John V. Cattie, Jr., Managing Attorney,

Cattie & Gonzalez, PLLC

Steven Shaw, Attorney & Certified Medicare Secondary Payer Professional,

Shaw Legal Solutions

Sylvius von Saucken, Esq., Vice President, Strategy and Advisory Services,

Epiq

If you’re interested in speaking, please contact Tim Hart at thart@risehealth.org

Chairperson Closing Remarks

Rafael Gonzalez, Esq., Partner

Cattie & Gonzalez, PLLC

Opening Remarks and Review of Day 1

Rafael Gonzalez, Esq., Partner

Cattie & Gonzalez, PLLC

Assess the Claims Reporting Process to Medicare

• Review Mandatory Insurer Reporting (MIR) requirements for defendants in liability, no-fault, and workers compensation claims
• Discuss reporting of Total Payment Obligation to Claimant (TPOC) on liability claims
• Assess reporting of ORM and ICD-10s on No-Fault and Workers Compensation claims
• Evaluate the importance of continuously updating Medicare of the status of the medical conditions and ongoing care

Logan Pry, Esq., Vice President, Medicare Compliance

Allan Koba Compliance Solutions

If you’re interested in speaking, please contact Tim Hart at thart@risehealth.org

Conditional Payments Resolution in Liability Claims

• Explore the conditional payment resolution process for defendants in personal injury, auto accidents, medical malpractice and product liability claims where no ORM accepted
• Assess the major differences within processes between the roles of the plaintiff and defense lawyer specific to reporting TPOC and ICD-10s
• Utilize industry best practices, including obtaining updates on conditional payments due throughout the life of the claim
• Obtain copy of final demand and reimbursement check to Medicare as part of settlement of the claim

Shannon P. Metcalf, Partner,

Hedrick Gardner Kincheloe & Garofalo, LLP

If you’re interested in speaking, please contact Tim Hart at thart@risehealth.org

Conditional Payments Resolution in No-Fault Claims

• Understand the outcomes on the decision to accept or deny ORM related to the claim
• Explore process if ORM is accepted through MIR to Medicare
• Comprehend available defenses to no-fault carrier throughout conditional payment resolution process
• Obtain a Conditional Payment Notice (CPN) and Final Demand from CRC in order to finalize resolution of conditional payments

Heather Schwartz Sanderson, Esq., President,

Sanderson Firm PLLC

If you’re interested in speaking, please contact Tim Hart at thart@risehealth.org

Conditional Payments Resolution in Workers Compensation Claims

• Analyze the process of resolving conditional payments with the CRC if employer or workers compensation accept ORM
• Discuss important communication and processes if ORM is not accepted
• Assess responsibilities of employer, carrier, defense lawyer, and lien negotiator to obtain information and resolve conditional payments made on the claim
• Understand what happens if the Applicable Plan does not reimburse Medicare

Brian MacAllister, CMSP-F, Senior Medicare Unit Manager, Conditional Payment Unit,

Liberty Mutual Insurance

If you’re interested in speaking, please contact Tim Hart at thart@risehealth.org

Conditional Payment Appeals Process

• Assess the similarities and differences for the appeals process for plaintiffs and defendants in liability, workers compensation, and no-fault claims
• Explore the redetermination process with the BCRC and CRC for an appeal, including documentation and applicable timelines
• Discuss processes for reconsideration at the BCRC and CRC to ensure all documentation required is prepared and submitted accurately and compliantly
• Examine best practices when preparing for a hearing before an ALJ for plaintiffs and defendants in liability, workers compensation, and no-fault claims

Amy Bilton, JD, MSCC, CMSP-F, Shareholder,

Nyhan Bambrick Kinzie & Lowry

If you’re interested in speaking, please contact Tim Hart at thart@risehealth.org

Conditional Payments Resolution in Mass Tort Claims

• Understand what a mass tort case consists of, and how it differentiates from single accident events
• Assess documentation and timelines needed to prepare for a mass tort case
• Discuss best practices dealing with Medicare post resolution of mass tort case, and understand process of global resolution of conditional payments

Sylvius von Saucken, Esq., Vice President, Strategy and Advisory Services,
Epiq

Industry Leader Wrap Up for Defense Conditional Payments

• Explore and discuss valuable takeaways from today’s discussion that will improve efficiency within the conditional payment process
• Analyze potential industry adjustments in the near future related to conditional payment to assess changes that need to be made
• Avoid cases from being referred to the Department of treasury/Justice by maximizing on best practices learned

Moderator

Rafael Gonzalez, Esq., Partner

Cattie & Gonzalez, PLLC

Panelists

Amy Bilton, JD, MSCC, CMSP-F, Shareholder,

Nyhan Bambrick Kinzie & Lowry

Heather Schwartz Sanderson, Esq., President,

Sanderson Firm PLLC

Logan Pry, Esq., Vice President, Medicare Compliance

Allan Koba Compliance Solutions

If you’re interested in speaking, please contact Tim Hart at thart@risehealth.org

Closing Remarks

Rafael Gonzalez, Esq., Partner

Cattie & Gonzalez, PLLC