The live-streaming virtual event will be held July 11-13 and will feature a four-part preconference workshop, 15 key sessions, and more than 20 industry leaders who will share critical insights on all components of the conditional payment process, including operational best practices and implementable solutions to improve your current workflows.

The 6th Annual Medicare Secondary Payer Conditional Payment Forum will return as a virtual event this summer with a particular focus on three key areas: Medicaid and third-party liens, conditional payments from the plaintiff’s perspective, and conditional payments from the defendant’s perspective.

Medicaid and third-party liens preconference workshop

Monday, July 11 will feature a four-part, pre-conference workshop where participants will hear from nationally recognized experts on how Medicaid and third-party liens impact Medicare Secondary Payer (MSP).

Part one of the workshop, an introduction to Medicaid and third-party liability liens, will be led by Rafael Gonzalez, Esq., partner, Cattie & Gonzalez, PLLC, and will explore the federal statute related to Medicaid and third-party liability liens, the federal regulations that apply to and must be abided by, the eligibility requirements for traditional Medicaid and Affordable Care Act expansion Medicaid, and how Medicaid generally processes outstanding liens.

Part two will be an introduction to U.S. Supreme Court cases on Medicaid third-party liability liens, with Robert Finley, partner, Hinshaw & Culbertson LLP, will look at the states’ position on entitlement to reimbursement of Medicaid liens, the Medicaid beneficiary’s position on states’ reimbursement rights, the U.S. Supreme Court case law on Ahlborn and how it changed Medicaid liens, and the U.S. Supreme Court case law on Wos and its effects on Medicaid liens.

Part three will be a state-by-state overview of Medicaid recovery systems across the U.S. Jason Lazarus, J.D., , founder, chief executive officer, Synergy Settlements, will discuss state and federal law after Ahlborn and Wos, how the major states’ Medicaid requirements differ (California, Texas, and Florida), and the process for reimbursement of a lien from each state to identify similarities and differences.

Part four will wrap up the workshop with a look at Gallardo v. Marstiller, a current case at U.S. Supreme Court, with John Cattie, Jr., managing attorney, Cattie & Gonzalez, PLLC. Cattie will review the background information of the case, the plaintiff arguments brought forward during the case, the state of Florida’s arguments in response, the federal government response to the case, and the potential implications of final decision on litigation of claims and solution of liens across the country.

Conditional payments from the plaintiff’s perspective

Tuesday, July 12 will consist of sessions that spotlight conditional payments from the plaintiff’s perspective. A few of the sessions include:

  • Examine the Medicare conditional payment process for plaintiff claims, a discussion around U.S. statutory provisions to better comprehend how they impact Medicare conditional payments, the Code of Federal Regulations to avoid potential errors, significant and trending case law to pinpoint common trends important to compliance, and the current CMS policy on the resolution of conditional payments in the various types of plaintiff claims at Commercial Repayment Center (CRC) and Benefits Coordination & Recovery Center (BCRC).
  • Conditional payments resolution in mass tort claims will shed light on what a mass tort case consists of and will also examine recent cases, the process to prepare for lien resolution in a mass tort case, including which documentation needs to be prepared, and the process of dealing with Medicare before and after mass tort case has been finalized, including global resolution of conditional payments.
  • Industry leader wrap up for plaintiff conditional payments, a panel discussion to spotlight key takeaways from the day’s discussion that will improve efficiency within the conditional payment process, potential changes on the horizon related to conditional payment to be better prepared, and best practices to prevent cases from being referred to the Department of Treasury and/or Department of Justice.

Conditional payments from the defendant’s perspective

The final day of the conference, Wednesday, July 13, will feature sessions around conditional payments from the defendant’s perspective. Sessions on the agenda include:

  • Assess the claims reporting process to Medicare will review Mandatory Insurer Reporting (MIR) requirements for defendants in liability, no-fault, and workers compensation claims, reporting of Total Payment Obligation to Claimant (TPOC) on liability claims, reporting of ongoing responsibility for medicals (ORM) and ICD-10 diagnosis codes on No-Fault and Workers Compensation claims, and the importance of continuously updating Medicare of the status of the medical conditions and ongoing care.
  • Conditional payments resolution in no-fault claims will discuss the outcomes on the decision to accept or deny ORM related to the claim, the process if ORM is accepted through mandatory insurer reporting (MIR) to Medicare, available defenses to no-fault carrier throughout conditional payment resolution process, and how to obtain a Conditional Payment Notice (CPN) and Final Demand from CRC to finalize resolution of conditional payments.
  • Conditional payment appeals process will assess the similarities and differences for the appeals process for plaintiffs and defendants in liability, workers compensation, and no-fault claims, the redetermination process with the BCRC and CRC for an appeal, including documentation and applicable timelines, the processes for reconsideration at the BCRC and CRC to ensure all documentation required is prepared and submitted accurately and compliantly, and best practices when preparing for a hearing before an Administrative Law Judge (ALJ) for plaintiffs and defendants in liability, workers compensation, and no-fault claims.

The 6th Annual Medicare Secondary Payer Conditional Payment Forum will be held as a live-streaming, virtual event July 11-13. Click here for the complete agenda and registration information.