Annual Conference Agenda

Detailed Annual Conference Agenda

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Below is the detailed agenda. To view the schedule-at-a-glance, please visit the agenda overview.

TIMES, TOPICS, AND SPEAKERS SUBJECT TO CHANGE

Wednesday, September 29. 2021
(All times are showing Eastern Standard Time)

Time	Function	Description
8:00 AM	Networking	Log-In and Network; Visit with Exhibitors Begin earning points toward the Leaderboard!
9:00 - 10:15 AM	Continuing Education	MSPN Hits on All Sixes: Updates from the Network Panelists: Daniel Anders, Esq, MSCC, Chief Compliance Officer, Tower MSA Partners / 2021 MSPN 2021 President; MSPN Committee Chairs The National Medicare Secondary Payer Network has been very busy this year! Hear from our executive board and committee chairs about what’s new! Learning Objectives: Discover what MSPN has been working on this year Learn what our committees are focusing on and what is to come Find out what MSPN has on the horizon
10:15 - 10:30 AM	Networking	Rejuvenation Time! Grab a cup of coffee and visit with a colleague!
10:30 - 11:30 AM	Continuing Education	The PAID Act - Get the Spill Panelists: Jim Brady, Program Director, BCRC ; Jackie Cipa, Deputy Director, Division of MSP Operations, CMS; Steve Forry, Division Director for MSP, Program Operations, CMS ; Angel Pagan, BCRC EDI Director, Technical Lead, GDIT. ; Heather Sanderson, Esq., MSCC, CHPE, CLMP, CMSP, President, Sanderson Firm, PLLC The Provide Accurate Information Directly (PAID) Act was enacted into law on December 11, 2020. Currently, workers’ compensation, general liability, and no-fault Responsible Reporting Entities (RREs) are limited to obtaining traditional Medicare Part A and B enrollment PAID Act information through the Section 111 Reporting query process. However, effective December 11, 2021, RREs will be able to learn of an injured party’s Medicare Advantage and Medicare Part D enrollment in the query process as well, so that if they choose, they may inquire with the Medicare Advantage or Part D plan as to any conditional payment liabilities. With Medicare Advantage enrollment at nearly 40% of the Medicare population, and Medicare Advantage plans filing numerous double damages MSP private cause of action lawsuits nationwide, PAID Act was a highly desired reform to the MSP Act. Learning Objectives: Understand the foundation and need for the PAID Act, particularly the increased litigation nationwide under the MSP Private Cause of Action by Medicare Advantage Plans. Comprehend the PAID Act’s purpose, and what additional information that RREs will receive as a result of the new law come December 2021. Prepare for the December 2021 implementation date and implement MSP Best Practices for Medicare Advantage and Part D.
11:30 AM - 12:30 PM	Continuing Education	MAO vs. Traditional Medicare: Similarities and Differences Panelist: Brian Bargender, CSRP, Internal Consultant, Humana; Rafael Gonzales, Esq., Partner, Cattie & Gonzalez While both traditional Medicare and Medicare Advantage Organizations provide medical benefits to beneficiaries, they use different methodologies in their recovery efforts. Learn about the different players, recovery models, notice requirements, recovery options, limitations and impact Medicare Set-Asides have on post-settlement medical coverage. Learning Objectives: Understand the legal differences in conditional payment recovery between traditional Medicare and Medicare Advantage Organizations (MAOs) Learn about differences in recovery models between MAOs Discuss the applicability of Chapter 7 of the Medicare Manuals to MAO recovery Learn what Section 111 information is transmitted to MAOs before and after settlement
12:30 - 1:30 PM	Networking	Take your lunch break while visiting with Exhibitors!
1:30 - 2:30 PM	Continuing Education	Avoiding the Bracelets - Civil Monetary Penalties Panelists: Nancy Harple, CMSP, MSCC, Claims Supervisor, Chesapeake Employers' Insurance Company; Amber Worman, Senior WC Claims Examiner, Montana Municipal Interlocal Authority As the industry awaits final rule-making on what constitutes a punishable offense, primary payers are fine tuning their Section 111 programs to avoid risks. This session will outline the proposed rules, common pitfalls and developing industry best practices for reporting. Learning Objectives: Become proficient in the laws giving rise to Section 111 reporting obligations Understand the basics of the proposed civil monetary penalty rules Apply those proposed rules to current industry practices and beyond
2:30 - 3:00 PM	Networking	It's Caffeination Time! Get your afternoon caffeine meet with some more of our exhibitors!
3:00 - 4:00 PM	Continuing Education	Breakout Session A: Section 111 Roadmap Panelist: Ciara Koba, Esq., Principal, Allan Koba Compliance Solutions; Angel Pagan, BCRC EDI Director, Technical Lead, GDIT Section 111 of the Medicare, Medicaid and SCHIP Extension Act created an online, mandatory reporting system for non-group health primary payers having ongoing responsibility for medical payments or who enter into settlements, judgments and awards with Medicare beneficiaries. While the idea seems straightforward, the devil is in the details. This session will walk attendees through what happens with that data after it reaches CMS, including how it is used by CMS to coordinate benefits, what is reported to Medicare Advantage Organizations and Prescription Drug Plans, how Section 111 reporting triggers different kinds of recovery and how CMS-approved Medicare Set-Asides fit in the process. Learning Objectives: Learn how CMS takes in Section 111 data and applies it to the Common Working File Understand more about coordination of benefits to the beneficiary and how Section 111 reporting can impact access to care Recognize how Section 111 reporting impacts the timing and claims made for conditional payment recovery Breakout Session B: MSP: What You Need to Know Panelist: Rasa Fumagalli, JD, MSCC, CMSP-F, Director of MSP Compliance Services, Synergy Settlement Services; Annemarie Pantazis, Esq., Managing Attorney, Wilder Pantazis Law Group; Jennifer Shymanski, Esq., CMSP-F, Vice President of Implementation and Strategy, Nuquest Medicare Secondary Payer law and rules are complicated and can have a powerful impact on a beneficiary’s pre- and post-claim life. This session will provide an overview of the basics of Medicare Secondary Payer processes and procedures and how a practitioner should address Medicare issues in their cases. Learning Objectives: Master the basics of Medicare’s underlying pre- and post-settlement rights and processes Learn which tools are available to determine conditional payment amounts and options for satisfying reimbursement obligations Identify options for future medical considerations in all types of litigation Breakout Session C: Red Book: Fact or Fiction Panelist: Steven Miller, MSPharm, DPh, RPh, CMSP-F, President, PharmacyMSA; Leslie Schumacher, RN, CRRN, CCM, LNCC, CLCP, MSCC, CMSP, President, PlanPoint The Workers’ Compensation Medicare Set-Aside Reference Guide states CMS uses Average Wholesale Pricing (AWP) per the current Red Book Drug Reference to price medications in a Workers’ Compensation Medicare Set-Aside Arrangement. AWP pricing rarely matches state law limits or pharmacy benefit management pricing. Post-settlement, beneficiaries will likely pay for their medication at different rates. Is Red Book the best option? Learning Objectives: Recognize other drug pricing methodologies used by CMS and other organizations Compare actual versus AWP pricing to understand real-life disparities Understand the post-settlement implications WCMSA AWP pricing has on beneficiaries and their ability to obtain post-settlement medications
4:00 - 5:00 PM	Continuing Education	Breakout Session A: CMPs: A Granular Look Panelists: Lavonya Chapman, Esq., BSN, CMSP, MSP Compliance Counsel, Optum Settlement; Jeremy Farquhar, Senior Product Consultant, ISO Claims Partners Civil monetary penalties are the hot topic and there still are a lot of unknowns. Prior to the proposed rule, the focus was on technical errors. Now that we know there are other instances where a Responsible Reporting Entity (RRE) may be penalized, how does the industry get its house in order? Take a deep dive into the proposed rule and best practices to implement now. Learning Objectives: Learn the intricacies of the proposed rule Explore examples of how errors can be grounds for penalties Examine ways contradictory or incomplete data provided to Medicare can pose risk Breakout Session B: Liability on Trial Panelists: John Cattie, Esq., Founding Member, Cattie, PLLC; Annie Davidson, Esq., Sr. MSP Compliance Counsel & Policy Strategist, ExamWorks Compliance Solutions (moderator); Steve Shaw, Esq., President, Shaw Legal Solutions; Christina White, Esq., Senior Counsel, New York City Law Department While most of the Medicare Secondary Payer attention focuses on workers' compensation, liability claims present substantial and unique MSP compliance obstacles. Panel experts will discuss trial considerations specific to MSP compliance, including December 5, 1980 collateral source rules, use of special verdicts, and high/low settlements, etc. Learning Objectives: Learn the legal background of Medicare's status as a secondary payer of medical benefits, including the important of 12/5/1980. Analyze jurisdictional collateral source rules, consider special verdict implications, and understand the utility of high/low settlements. Develop strategies to comply with the MSP statute when facing trial. Breakout Session C: Safe Cracking: Reverse Engineering Your MSAs Panelist: Jennifer McClain, RN, BSN, CMSP-F, Nurse Consultant, Nyhan Bambrick Kinzie & Lowry; Christine Melancon, RN, CMSP-F,, Director of Regulatory Compliance, CLARA Analytics The last couple of years have been challenging for Medicare Set-Aside submitters. Changes to how CMS looks to major medical center pricing and procedure costs leave submitters asking questions. Learn how “reverse engineering” your approved MSAs can help improve accuracy of subsequent submissions. Learning Objectives: Identify items and services where the industry has seen changes in WCMSA pricing Grasp new tactics for determining how to recreate patterns in these pricing changes Optimize the use of your counter-decisions and other data to achieve accuracy and matches in subsequent submissions
5:00 - 6:00 PM	Continuing Education	Breakout Session A: Getting Your House in Order: Section 111 Auditing & Clean Up Panelists: Frank Fairchok, Vice President of Medicare Reporting Services, MEDVAL; Suzanne Jordan, SCHIP Compliance Manager, Broadspire With civil monetary penalties on the horizon, data clean-up and streamlining reporting efficiencies are priorities for responsible reporting entities. Our expert panel will go through how to approach your data clean-up and explain how to reduce error responses. Learning Objectives: Learn how to identify errors which could lead to later penalties Identify when your data which may need clean-up Discover how to better work with your Section 111 reporting company to avoid errors Breakout Session B: Post Settlement Pitfalls Panelists: Jason Lazarus, JD, LLM, CSSC, MSCC, Chief Executive Officer, Synergy Settlement Services; Jack Meligan, MSCC, CMSP-F, President, The Plaintiffs MSA & Lien Solution Once the settlement ink is dry and the checks issued, a Medicare beneficiary’s life continues on. Medicare may seek reimbursement from the claimant for conditional payments not paid by the carrier. Their medical providers may accidentally bill Medicare for injury-related items and services. Their Medicare Set-Aside may exhaust. Their mental status may dramatically change, making it difficult or impossible to handle their MSA or other settlement monies. Our panel of experts will guide you through the post-settlement minefield and provide real-life, constructive recommendations on how to limit post-settlement concerns. Learning Objectives: Identify post-settlement pitfalls an injured person and their attorney could face Determine best options for mitigating post-settlement problems Learn best practices for post-settlement handling of conditional payments and future medical monies Breakout Session C: Catastrophic Claims: Unique Considerations Panelists: David Korch, JD, AIC, SCLA, CMSP, CMSS, Vice President, Arcadia Settlement Group; Jennifer Mislanovich, JD, Division Manager, MEDVAL; Monica Williams, RN, CCM, CRRN, LNC, MSCC, CMSP, CNLCP, Manager Medicare Compliance, Innovative Claims Strategies Catastrophic workers’ compensation claims are handled differently than other workers’ compensation claims. How does handling conditional payment reimbursement or a Medicare Set-Aside in a catastrophic claim differ from other claims? Learning Objectives: Learn the differences between “regular” and catastrophic workers’ compensation claims Identify how WC claim decisions impact conditional payment recovery and Medicare Set-Asides Recognize special issues needing consideration in catastrophic claims, including interplay with Medicaid, trusts and MSA administration
6:30 - 8:30 PM	Networking	Casino Night Speakeasy Extra time to earn Leaderboard Points!

Thursday, September 30, 2021
(All times are showing Eastern Standard Time)

Time	Function	Description
7:00 AM	Networking	Log-in and Network; Visit with Exhibitors Continue earning points for the Leaderboard!
8:00 - 9:00 AM	Continuing Education	Surviving Surgical Pricing & Major Medical Centers Panelist: Adriana Begley, MSCC, Quality Manager/WCRC Litigation Contact, Capitol Bridge; Amy Bilton, Esq., MSCC, CMSP-F, Shareholder, Nyhan Bambrick Kinzie & Lowry; Holly Havens, WCRC Project Director, Capitol Bridge; John Jenkins, MSHS, MSHA, Health Insurance Specialist, CMS In 2020, CMS added a list of major medical centers it uses for pricing to the WCMSA Reference Guide to assist submitters in accurately estimating future medical treatment costs in the MSA, but the details of how to apply major medical center pricing remains a mystery to the industry. The April 19, 2021 Reference Guide revamped how seed money to cover future surgical procedures should be calculated. Learn about how these new additions have changed MSA submissions and what remains unclear to submitters. Learning Objectives: Understand the most recent changes to surgical pricing from the Reference Guides published over the last year Learn how major medical center pricing appears to be used and when it applies Recognize how seed money calculations have changed and why
9:00 - 10:00 AM	Continuing Education	Behind the Scenes: WCRC Panelist: Michelle Allan, Esq., Principal, Allan Koba Compliance Solutions; John Jenkins, MSHS, MSHA, Health Insurance Specialist, CMS The Workers’ Compensation Review Contractor diligently processes and reviews WCMSA reports and issues decisions. Each Medicare Set-Aside must be formatted and positioned properly to undergo optimal review. Submitters want to avoid development requests, counter-higher decisions and delays in MSA processing. Learn how to best position your submission for optimal results. Learning Objectives: Identify current trending with WCMSA determinations Understand WCMSA submission requirements and how to properly submit Decide how WCRC activities impact your MSA submissions
10:00 - 10:15 AM	Networking	Get up and Stretch! Pop into the Exhibit Hall and look for more ways to earn your Leaderboard points.
10:15 AM - 12:15 PM	Continuing Education	Distilling The Eight Ball Panelists: John Albert, Senior Technical Advisor, Division of MSP Operations Office of Financial Management, CMS; Jim Brady, Program Director, BCRC; Patrick Czuprynski, Esq., MSCC, Director of Lien Resolution, NuQuest; Annie Davidson, Esq., Sr. MSP Compliance Counsel & Policy Strategist, ExamWorks Compliance Solutions ; Ted Doyle, MA, AHFI, DFE, CIFI, Project Director, CRC; Nicole Griffin, CRC Director, MSP Recoveries, Performant Corp; Kathleen Hunter, BCRC Director Correspondence Processing, Group Health, Inc.; Jill Jimenez, Manager, Healthcare Billing Recovery Operations Programs, Performant Corp; Renee Jones, BCRC CFW Manager, Group Health, Inc.; Brian MacAllister, AIC, MSCC, CMSP-F, Director, Conditional Payments, Liberty Mutual Companies ; Yasmin Mukhtar, Esq., Supervisor, Post Adjudication, QIC Part A, Maximus ; Mileyka Ojeda, NGHP Healthcare Billing & Recovery Manager, MSP Commercial Repayment Center, Performant Corp; Angel Pagan, BCRC EDI Director, Technical Lead, GDIT; Will Sykes, BCRC Director Call Center, Group Health Inc. The panelists will explore the differences between the two recovery models, how each contractor uses claims groupers, how the revised Chapter 7 of the Medicare Manual will impact recovery, how the QIC fits into these processes, and how the BCRC and CRC handle redundant and duplicative recovery claims. They will also address taking appeals to the Qualified Independent Contractor, Administrative Law Judge, and Medicare Appeals Council. Learning Objectives: Understand the intricacies of each conditional payment recovery model and how settlement can impact recovery efforts Identify where claims overlap and how to navigate recovery if claims move from the CRC to the BCRC Explore how best to handle conditional payments at settlement given that parties are jointly and severally liable, while the current recovery processes identify one debtor over another Grasp the various levels of dispute and appeal and to whom they are sent Distinguish between formal and informal challenges and what materials are necessary Learn practice tips to defend your position and save money
12:15 - 1:15 PM	Continuing Education	Lunch and Learn: Legal-ease: A Legislative and Regulatory Update Panelist: David Farber, Esq., Partner, King & Spalding / MARC Representative Medicare Secondary Payer case law, legislation and regulations frequently involve dense verbiage and meandering dicta, making it difficult to find the bright line rule. This session will demystify the latest and greatest legal developments, offering a clear description of the laws and how they impact day-to-day business. Learning Objectives: Obtain a critical analysis of case law specifics as well as their utility and limitations Peruse proposed legislation, its posture and what passage would mean to the industry Discover nuances posed by regulation and how they support existing laws
1:15 - 2:15 PM	Continuing Education	Post Script: What Happens After Settlement Panelists: Shawn Deane, MSCC, CMSP, General Counsel, Ametros; Patrick Hindert, JD, CSCC, Vice President of Business Development, Independent Life; Aaron Winnell, CMSP, Vice President of Operations, Medivest Once a case is settled and a file closed, payers often wash their hands of further responsibility. But what happens after settlement? How do beneficiaries navigate the confusing waters of their post-settlement MSP obligations? How can beneficiaries be sure their settlement funds are sufficient to cover their post-settlement needs? And what happens if the money runs out? Our panelists will talk through post-settlement concerns and how to address them. Learning Objectives: Acknowledge what Medicare Set-Asides do not cover and what you need to know about those items and services at settlement Recognize the limitations of Medicare Set-Asides and how to make the money go farther Determine options available if money is misspent or otherwise exhausted
2:15 - 3:15 PM	Continuing Education	Don't Sacrifice the Safety Net Panelists: Ron Feinman, Esq., Partner Planner, Synergy Settlement Services; Krista Johnson, Senior Director, Special Programs, Ametros Financial; Elena Lidrbauch, Esq., CELA, Shareholder, Hickman & Lowder Beyond the range of Medicare Set-Asides, Conditional Payments and Section 111 reporting are the second-tier realities associated with settlements. Medicaid entitlements and reimbursements, as well as special needs trust are a natural extension of Medicare Secondary Payer concerns. This session will explore the scope of these next level implications and examine the ethical challenges they present. Learning Objectives: Analysis of Medicaid Secondary Payer rules and how they impact settlements Understanding what triggers the need for a Special Needs Trust and what it protects against Awareness of the ethical issues and how to ensure appropriate resources are employed
3:15 - 3:30 PM	Networking	Grab a snack and Visit with Colleagues Take a final stroll through the Exhibit Hall!
3:30 - 4:30 PM	Continuing Education	Wishlist Panelists: Beth Hostetler, BSN, Director of Medicare Services, Risk Management, Albertsons; John Kane, CMSP, Vice-President of Strategy, Ametros; Mark Popolizio, Esq., Vice President, MSP Compliance and Policy, ISO Claims Partners; Kevin Puckett, President/Owner, KP Underwriting, LLC A fan favorite! If you ruled the world of MSP, what would you change? Why? What can be improved upon in this process? Our expert panelists will take a look at each of these questions and provide their thoughts on how they would like to see the conditional payment recovery and Medicare Set-Aside processes grow and change. Learning Objectives: Identify areas where the conditional payment and Medicare Set-Aside processes could be looked at with a proactive and productive eye toward improvement Recognize areas where the MSP Network is working with, or should try to work with, CMS to address real-life concerns with current processes Identify what beneficiaries and their attorneys may want to pay attention to avoid later losses or reductions in benefits
4:30 - 4:45 PM	Networking	Final Opportunity to Earn Leaderboard points!
4:45 - 5:45 PM	Continuing Education	CMS Fireside Chat Panelists: Daniel Anders, Esq., MSCC, Chief Compliance Officer, Tower MSA Partners; Jackie Cipa, Deputy Director, Division of MSP Operations, CMS; Steve Forry, Division Director for MSPN, Program Operations, CMS Pull up your seat and gather ‘round the hearth for a rousing conclusion to the Conference. Join CMS in winding down the recent sessions with insights and commentary on areas of relevance and import to our community. This session provides a robust roundup of meaningful takeaways and emergent issues in the Medicare Secondary Payer universe. Learning Objectives: Synthesis of course content and its relevance to day-to-day practices Identification of advocacy efforts and troubleshooting measures Awareness of issues and consideration on the horizon
5:45 - 6:00 PM	Closing	That's the Crop: Conference Send-Off and Prize Announcements Leaderboard Winners

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