Agenda

February 3, 2020

7:50AM – 8:50AM
Registration and Networking Breakfast

8:50AM – 9:00AM

Welcome Remarks

Rafael Gonzalez, Esq., President, Settlement Solutions, Workers Compensation and Auto No-Fault
UnitedHealth Group/Optum

9:00AM – 9:45AM

Legislative and Legal: An Analysis of the Impact of the New Civil Monetary Penalty Rules

  • Interpret the new civil monetary penalty rules regarding mandatory reporting non-compliance
  • Discuss changes and concerns related to the new CMPs
  • Distinguish if the rules will apply retroactively and the possibility of RREs disputing or appealing penalties

 

Frank Fairchok, VP, Medicare Reporting and Development
Optum Work Comp and Auto No-Fault

 

Vanessa Lipsky, Partner/Section Lead Medicare Compliance Department
Eraclides Gelman Attorneys at Law

9:45AM – 10:45AM

Legislative and Legal: A discussion on the Significance of the New Medicare Set-Aside Regulations

  • Evaluate if Medicare set-asides are now mandatory in auto, liability, no-fault, and work comp cases
  • Clarify if submission of MSAs to CMS for review is still voluntary
  • Differentiate between Workers Compensation, Liability and No-Fault MSAs

 

Rafael Gonzalez, Esq., President, Settlement Solutions, Workers Compensation and Auto No-Fault
UnitedHealth Group/Optum

 

Heather Hatch, Partner
The Chartwell Law Offices, LLP

 

10:45AM – 11:00AM
Networking Break

11:00AM – 11:45AM

Legislative and Legal: Deep Dive: Update on Pending Workers Compensation Medicare Set Asides Legislation

  • Analyze the positive and negative points of WCMSA legislation introduced in 2019
  • Consider the actions taken by the WCMSA contractor regarding life expectancy, medical care, and prescriptions
  • Examine current MSA trends on work comp medical, ancillary, and pharmacy

 

Kevin Tribout, Executive Director, Government Relations
Optum Work Comp and Auto No-Fault

 

Doug Holmes, Esq., President
UWC

11:45AM – 12:30PM

Legislative and Legal: Case Law Update on Liability, No Fault, and Workers Compensation Medicare Secondary Payer Issues

  • Review of case law update on mandatory insurer reporting issues
  • Explore case law update on traditional Medicare and advantage plan conditional payment resolution
  • Comb through case law update on auto, liability, no-fault, and work comp Medicare set-asides

 

Rachel LaMontagne, Esq., Partner
Shutts & Bowen

Jean Goldstein, Senior Legal Counsel, MSP Compliance
Medval

12:30PM – 1:30PM
Networking Lunch

1:30PM – 2:15PM

Mandatory Reporting: Successful Reporting of Ongoing Responsibility for Medical (ORM) in No Fault and Workers Compensation Claims

  • Identify when Workers Compensation and No-Fault RRE are obligated to report ORM
  • Classify exactly when and under what circumstances can an RRE terminate ORM
  • Consider best practice recommendations for creating an internal program to report ORM

 

Frank Fairchok, VP, Medicare Reporting and Development
Optum Work Comp and Auto No-Fault

 

Suzanne Jordan, SCHIP Compliance Manager 
Broadspire

2:15PM – 3:00PM

Mandatory Reporting: Best Practices when Reporting ICD Codes in Liability, No Fault, and Workers Compensation

  • Overview and comprehensive understanding of the 2010 International Classification of Disease codes
  • Strategies for creating an internal program to report ICDs
  • Probe through a case study on determining the appropriate ICD-10 to report to CMS

 

Monica Williams, Medicare Compliance Manager
Innovative Claims Strategies

 

Deborah Watkins, Founder & Chief Disruption Officer
Care Bridge International

3:00PM – 3:30PM
Networking Break

3:30PM – 4:15PM

Mandatory Reporting: Efficient Reporting of Total Payment Obligation to Claimant (TPOC) in Liability, No Fault, and Workers Compensation

  • Define Total Payment Obligation to Claimant to encompass a thorough understanding
  • Pin-point when Total Payment Obligation to Claimant is reportable to CMS
  • Best practices and recommendations for creating an internal program to report TPOC
  • Consider the consequences of not reporting TPOC
  • Review processes triggered at CMS when TPOC is reported

Robert Finley, Esq., Partner
Hinshaw Law

Suzanne Jordan, SCHIP Compliance Manager 
Broadspire

4:15PM – 5:00PM

Mandatory Reporting: Analyze the Effect of Mandatory Insurer Reporting (MIR) is Having on Conditional Payment Recovery

  • Express why mandatory insurer reporting is now key for CMS visibility into a claim
  • Examine the differences and changes mandatory insurer reporting has on the conditional payment resolution process
  • Interpret the impact mandatory insurer reporting has made on the Medicare set aside allocation process

 

Rose Arellano, Director of Outreach Recovery
Performant Financial Corporation

LaVonya Chapman, RN, Esq., Associate General Counsel, Settlement Solutions
UnitedHealth/Optum Workers Compensation and Auto No-Fault

5:00PM-5:20PM

RISE Presentation

5:20PM – 6:20PM
Networking Cocktail Reception

February 4, 2020

7:35AM – 8:35AM
Networking Breakfast

8:35AM – 8:45AM

Opening Remarks

Rafael Gonzalez, Esq., President, Settlement Solutions, Workers Compensation and Auto No-Fault
UnitedHealth Group/Optum

8:45AM – 9:30AM

Conditional Payments: Strategies to Resolve Conditional Payments Pre-Settlement with the Commercial Repayment Center (CRC)

  • Understand the CRC’s process for resolution of conditional payments in pre-settlement ORM matters
  • Consider best practice recommendations for creating an internal CPR program
  • Review updates on the latest CRC procedural changes and their effects on your NF and WC claim

 

Rose Arellano, Director of Outreach Recovery
Performant Financial Corporation

 

Amy Bilton, Partner
Nyhan Bambrick Kinzie & Lowry

 

Ted Doyle, VP, Healthcare Markets
Performant Financial Corporation
(Invited)

9:30AM – 10:15AM

Conditional Payments: Best Practices for Resolving Conditional Payments Post-Settlement with the Benefits Coordination and Recovery Center (BCRC)

 

  • Comprehend the BCRC’s process for resolution of conditional payments in post-settlement matters
  • Analyze industry best practice recommendations for creating an internal CPR program
  • Dissect updates on the latest BCRC procedural changes and their effects on your LB and WC claim

 

John V. Cattie, Jr., Founding Member
Cattie, P.L.L.C.

Robert Finley, Esq., Partner
Hinshaw Law

Michelle Allan, Partner
Gordon Rees Scully Mansukhani

10:15AM – 10:30AM
Networking Break

10:30AM – 11:15AM

Conditional Payments: Explore the Process of Resolving Conditional Payments with the U.S. Treasury

  • Discuss the impact of the process from CRC’s demand, to notice of intent to refer, to dealing with the Treasury
  • Explain in detail reasons for files referred to the Treasury after a timely appeal or payment to CMS
  • Examine potential responses for RREs after the Treasury has offset the debt

Vanessa Lipsky, Partner/Section Lead Medicare Compliance Department
Eraclides Gelman Attorneys at Law

 

Rafael Gonzalez, Esq., President, Settlement Solutions, Workers Compensation and Auto No-Fault
UnitedHealth Group/Optum

11:15AM – 12:00PM

Conditional Payments: Best Practices for Resolving Conditional Payments with Medicare Advantage Plans

  • In depth overview of how Medicare Advantage (MA) plans fit into the Medicare program and related issues in MSP enforcement
  • Proven best practices for avoiding MSP conflicts with emphasis on understanding how CMS shares data collected from NGHPs with MA plans and treatment providers
  • Explore opportunities for NGHPs and MA plans to work together to maintain compliance with MSP requirements

Monica McGovern, Medicare Reporting and Process Manager
Allstate

Brian Bargender, Internal Consultant
Humana

12:00PM – 12:45PM
Networking Lunch

12:45PM – 1:30PM

Medicare Set-Asides: Overview: An Industry Update on Workers Compensation Medicare Set-Asides

  • Analyze the traditional WC Medicare set aside, built on CMS guidelines of review and approval
  • Discuss the non-submit WC Medicare set aside, built on evidence, medical guidelines, and state law
  • Examine the data driven WC Medicare set aside, built on group health and work comp private data

 

Monica Williams, Medicare Compliance Manager
Innovative Claims Strategies

 

Deborah Watkins, Founder & Chief Disruption Officer
Care Bridge International

 

John V. Cattie, Jr., Founding Member
Cattie, P.L.L.C.

1:30PM – 2:15 PM

Medicare Set-Asides: An Update on Liability Medicare Set-Asides

  • Identify potential CMS Regional Offices that are reviewing Liability MSAs on a consistent basis
  • Strategies for taking Medicare’s future interests into account in a liability claim when future medical needs are greater than the settlement
  • Discuss the outcome when parties settle a liability claim without a Medicare set-aside

 

Robert Finley, Esq., Partner
Hinshaw Law

Amy Bilton, Partner,
Nyhan Bambrick Kinzie & Lowry

Michelle Allan, Partner
Gordon Rees Scully Mansukhani

2:15PM – 3:00PM

Medicare Set-Asides: An Update on Pharmacy Issues Related to Medicare Set-Asides

  • Recognize current trends on pharmacy issues in Workers Compensation MSAs
  • Evaluate the pricing of pharmacy products and prescriptions in Workers Compensation MSAs
  • Strategies to mitigate pharmacy costs in Workers Compensation MSAs

 

LaVonya Chapman, RN, Esq., Associate General Counsel, Settlement Solutions
UnitedHealth/Optum Workers Compensation and Auto No-Fault

 

Monica Williams, Medicare Compliance Manager
Innovative Claims Strategies

3:00 PM- 3:45PM

Medicare Set-Asides: Trends in Medical, Pharmacy, and Ancillary Care in Medicare Set Asides

  • Explore current trends in medical care and how they affect Medicare set-aside allocations
  • Delve into current trends in pharmacy/prescriptions and how they affect Medicare set-aside allocations
  • Assess current trends in ancillary care and how they affect Medicare set-aside allocations

Heather Hatch, Partner,
The Chartwell Law Offices, LLP

Jean Goldstein, Senior Legal Counsel, MSP Compliance
Medval

3:45PM- 4:00PM

Closing Remarks

Rafael Gonzalez, Esq., President, Settlement Solutions, Workers Compensation and Auto No-Fault
UnitedHealth Group/Optum