Module 1: Overview of MSP Compliance

Presenter: Mark Popolizio, Esq.

This module will identify key case decisions involving Medicare Secondary Payer and analyze how these decisions impact every day claims and settlements. At the end of the module, you will have an understanding of how the court’s analyses and holdings can be used to improve best practices.

Module 2: CMS Policy Memo

Presenter: Thomas Spratt, MSCC

Module 2 will provide an overview of CMS policies and procedures. You will review memos which serve as the “Blueprint” of CMS’ views concerning compliance with workers’ comp matters. Such memos include CMS’ 2001 memo introducing MSP and Workers’ Compensation. Finally, this module will review the current WC Reference Guide.

Module 3: Medicare Secondary Payer: The Players and Their Role

Presenter: Kimberly Wiswell, CMSP

Module 3 will identify and define the roles of the “players” of MSA. Those players include the claimant, payer, attorneys, provider, MSA allocator, brokers, custodial administration, social security administration, CMS central and regional offices, CMS WC review contractors, and CMS recovery contractors.

Module 4: Structured Settlements & Rated Ages

Presenters: David Korch, JD, AIC, SCLA, CMSP, CMSS
Kevin Pucket, AALU, ACS

Module 4 will review what is a structured settlement, as well as provide guidance for structuring the MSAE. The module includes direction on additional topics around settlements, such as funding, rated ages, savings, and Medicaid. You will review information relative to rated ages and life expectancies, as well as acceptable types of medical records and ratable medical conditions.

Module 5: Administration & Custodial Accounts

Presenter: Robert J Sagrillo, JD, LLM

This module will focus on the legal requirements relative to WCMSA administration, including CMS guidance. You will examine funding, use and exhaustion of WCMSA funds. Finally, this module will compare and contrast professional administration and self administration.

Module 6: Medicare Conditional Payments

Presenter: Shawn Deane, JD, MEd, MSCC, CMSP

This module will focus on Medicare conditional payments. It will provide an overview of conditional payments, with terms defined, a breakdown of the applicable contractors (current as of the time of the recording), and will cover the conditional payment process. This process includes obtaining information, authorizations, types of correspondence, anatomy of PSF/SOR, disputes, demands, and appeals process. At the end of this module, there are two brief sections covering the functionality of the Medicare Secondary Payer Recovery Portal (MSPRP) with the expedited CP process, as well as U.S. Department of Treasury collections.

Module 7: Development of the MSA Allocation Cost Projection

Presenters: Fran Provenzano, RN, BSN, CDMS, CCM, CLCP, MSCC, CMSP, CMSP
Leslie Schumacher, RN, CRRN, CCM, LNCC, CLCP, CNLCP, MSCC, CMSP

Module 7 will analyze the trends in WC Review Center recommendations determining Medicare allowable care resources. The module will review the diagnosis codes for CPT coding, WC reimbursement schedules, and CMS calculation requirements. You will also learn the process for submitting the MSA Arrangement to CMS for approval, including guidance relative to the supporting documentation required.

Module 8: Electronic Reporting

Presenter: Shawn Deane, JD, MEd, MSCC, CMSP

This module will focus on Sec. 111 Medicare Mandatory Insurer Reporting, covering terminology, and the full query process.

Module 9: Roundtable Wrap-up

Presenters: Fran Provenzano, RN, BSN, CDMS, CCM, CLCP, MSCC, CMSP, CMSP
Leslie Schumacher, RN, CRRN, CCM, LNCC, CLCP, CNLCP, MSCC, CMSP
Christine Melancon, RN, CCM, MSCC, CNLCP, CMSP
Thomas Spratt, MSCC

The final module is discussion on highlights and points of concern reviewed in the previous eight modules. This module is a summary designed to prepare you for the practicum portion of the MSCC Training Program.