Rise

Opening Remarks and Review of Day 1

Rafael Gonzalez, Esq., President

Medicare & Medicaid Compliance 

Discuss the Value of the Claimant Being in Control of Liability Claims

• Understand that If no ORM is accepted then the claimant is the responsible debtor 
• Examine types of claims such as medical malpractice, nursing home litigation, motor vehicle accidents, and products liability for conditional payments resolution 
• Discuss critical information that the plaintiff or plaintiff’s attorney must share with CMS to confirm that Medicare is aware of the pending lawsuit 
• Analyze when and how to revisit and update the claim to assure CMS has timely and pertinent information  

Jason Lazarus, J.D., LL.M., MSCC, CSSC, Founder, Chief Executive Officer

Synergy Settlements 

Session Transition

Strategies when Dealing with the BCRC in the Early Stages of Your Claim

• Request a Conditional Payment letter from BCRC to receive information on which Conditional Payments CMS has made on an interim basis 
• Utilize tips on how to analyze the BCRC Conditional Payment letter to determine if Medicare’s payments are in fact related to case at hand 
• Dispute Conditional Payments in the early stages of your claim 

Speaker to be announced 

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

Session Transition

Tactics when Working with the BCRC Throughout Life of the Claim

• Request updated Conditional Payment Letters from CMS throughout the life of the claim to catch expensive errors as they occur 
• Re-analyze and dispute with BCRC to have mistakes rectified in a timely manner 
• Avoid surprises at the end of the claim by revisiting interim conditional payments again and again all the way thru settlement 

Christine M. Franco, Esq. 

Franco Law Group 

Session Transition

Best Practices when Dealing with the BCRC Post Settlement

• Discuss the critical component of claimant requesting a final demand to close out the case after a settlement has been agreed  
• Analyze the final demand with a fine-tooth comb as it’s the last chance to dispute any conditional payments request mistakes in the claim 
• Prepare to make payment within 60 days to Medicare for all expenses related to the claim on the final demand 
• Examine the outcome if payment is not made, including referral of claim to Departments of Treasury or Justice 

Shawn Deane, Esq., General Counsel 

Ametros 

John V. Cattie, Jr., Founding Member 

Cattie, P.L.L.C. 

Lunch - Virtual Networking Lounge

Don’t Miss Out! Turn on your camera and join us in the Virtual Lobby for that face-to-face networking experience we’ve all been missing. Connecting with your peers and vendors including MSP professionals from across the country never been easier - click on an open seat, say hello to familiar faces, and take part in conditional payments, Medicare Set-Asides, and mandatory reporting discussions. We’ll see you in the lobby! 

Evaluate the Benefits of the Primary Payer having Control in No-Fault and Workers Compensation Claims

• Understand that If ORM is accepted then the defendant is the responsible debtor and will be held accountable for reimbursement of Conditional Payments 
• Define the types of claims including personal injury protection, med pay policies, no-fault, homeowner’s policies, and workers compensation, to identify which Conditional Payment is owed by the debtor 
• Report information regarding the claim through Mandatory Insurer Reporting to ensure CMS has all pertinent information  
• Update ORM and ICDs on a quarterly basis to keep CMS informed of details of file 

Speaker to be announced 

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

Session Transition

Proven Methods when Working with the CRC Pre-Settlement and Post-Settlement

• Receive a Conditional Payment Notice generated by CRC in relation to the claim, or request a CPN If not automatically generated by the CRC to receive conditional payment information related to claim  
• Dispute unrelated charges in the Conditional Payment Notice within 30-days  
• Next Steps: Analyze BCRC’s request for payment, the Conditional Payment Demand, 
• Prepare to pay within 60-days or appeal non-related Conditional Payments within 120-Days

Melisa Zwilling , Attorney,
Carr Allison Medicare Compliance Group

Reinaldo Alvarez, Junior Partner,
Luks Santaniello

Session Transition

Valuable Techniques when Dealing with Medicare Advantage and Prescription Drug Plans

• Calculate new approaches to identify if a claimant has transitioned from traditional Medicare to Medicare Advantage or Prescription Drug Plan 
• Connect with Medicare Advantage Plan or Prescription Drug Plan to determine if any payments have been made related to the claim 
• Analyze payment log of items paid to make a determination if payments made are related and if not, to dispute errors 
• Avoid being sued for double damages by ensuring your dispute with Medicare Advantage or Prescription Drug Plan is accurate and timely 

Brian Bargender, CSRP, Management Consultant, Subrogation and Other Payer Liability

Humana 

Rachel LaMontagne, Partner,

Shutts & Bowen

Session Transition

Established Strategies when Working with US Department of Treasury and US Department of Justice

• Understand process if no payment or appeal is made and examine the outcome of claim escalation of outstanding debt when referred to the US Department of Treasury 
• Prepare to receive forceful communication from the US Department of Treasury Collectors, as they attempt to reclaim outstanding debt 
• Strategies to resolve if debt remains unpaid, dealing with US Department of Treasury Offset Program 
• Avoid being sued by the US Department of Justice for unpaid debts related to claim 

Ciara Koba, Principal
Allan Koba Compliance Solutions

Robert Finley, Esq., Partner
Hinshaw Law

Closing Remarks

Rafael Gonzalez, Esq., President

Medicare & Medicaid Compliance