It’s Time for P&C Insurers to Learn Medicare’s Secondary Payer Rights

Posted by Kendell Gracey on Dec 18, 2014 10:44:00 AM

wc_annual-1The 23rd annual National Workers' Compensation and Disability Conference was held on November 19-21, 2014.  The biggest event of its kind, this year's conference enjoyed a record breaking attendance for the fifth year in a row.

On Thursday, November 20, at 8:30 am, a breakout session was held that really piqued our interest here at Flagship Services Group: Workers' Compensation and its Secondary Payers: Medicare and Medicaid.  The presentation was led by Vernon Sumwalt and Tim Nay, both attorneys with years of experience in workers' compensation (in Sumwalt's case) and Medicare Second Payer Compliance (in Nay's case.)  The discussion was moderated by Jennifer C. Jordan of MEDVAL, LLC., a nationally recognized expert in Medicare compliance.

The key takeaway from the discussion had to do with the new laws that have been enacted by Congress, and are set to go into effect in October of 2016, which will essentially make Medicaid very similar to Medicare in both the reporting and recovery aspects of its role as secondary payer.

While the discussion centered primarily around how this affects workers' compensation claims, the same principles apply equally well to the personal injury side of the picture that we specialize in.  

Here is a brief synopsis of the key elements of the conference discussion, as provided by the conference website:

“While the SMART Act has improved access to Medicare conditional payment information and streamlined MSP reimbursements, a new law has thrown a wrench into the works by strengthening Medicaid's reimbursement rights, making them very similar to Medicare's. Is this the start of yet another new trend to further enhance Medicaid's secondary payer rights and address its future medical expenses? With the new law set to take effect October 2016, you need to know if you’ll be facing long term care expenses on top of Medicare set-asides – and significant delays in settlements. Get all the facts and find out what adjustments you’ll need to make to be in the best position.”

This offers a valid wake up call for P&C insurance carriers who may not have noted the sea of change this new law created.  In less than two years, Medicaid becomes a larger player than Medicare, and the fact that each state has its own unique laws and requirements involving Medicaid claims means the landscape is going to become even more complex, especially for large insurers with customers in multiple states.

At Flagship, we've always maintained an eagle eye on the ever-changing Medicare and Medicaid laws.

Learn more about why regulatory compliance should be a top concern for P&C insurers.

 

New Call-to-action