NAMSAP Quarterly Newsletter
Volume 9, Number 4                                                                                                                November 2016
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Special Thank You 
To Our Professional Partners!
Gold  Partners 
Silver Partners 
Bronze Partners 
President's Reflection
By: Gary Patureau, CWCP, CMSP
Executive Director/COO,  Louisiana Association of Self-Insured Employers

As my year as president winds down, I would like to thank all of you for your strong support of NAMSAP.  I believe that NAMSAP as an organization has been developing into a more pro-active industry leader for the past couple of years and 2016 was an outstanding year in this area.  Part of that growth was due to solid guidance from our Executive Director, Brian Bailey.  Brian and his team did an outstanding job in supporting the work of the board.  Brian recently moved back to the Washington, DC area for a new career opportunity.  He is the Director of Safety & Environmental Stewardship at American Waterways Operators.  I would like to thank Brian for his hard work for NAMSAP. 

I would like to introduce Paul Hiller, our new Executive Director.  Paul comes to NAMSAP with significant association management experience in meetings, membership, committee management and education program development. In Paul's decade long run with the Orthopaedic Trauma Association, his marketing focus grew the membership from 800 to over 2,000 and expanded its annual meeting attendance for nine consecutive years. Paul earned his Certified Meeting Professional designation in 2014 and served on the Medical Meetings Task Force of the Professional Convention and Meetings Association in 2015. Paul is excited to bring his talents to NAMSAP to help the organization achieve it mission and vision and we are excited to have him.

Click Here to read the entire article.
2016 Annual Meeting and Educational Conference 
Packed with great information, excellent speakers and an exciting scavenger hunt, NAMSAP's 2016 Annual Conference was the most widely attended NAMSAP event in the past 3 years.  For those who attended, I'm confident that the information communicated has already brought value to you and your respective organizations.  For those who were unable to attend, or who could not attend every session, the articles and summaries below should provide you with excellent content and differing perspectives on some of the key issues and concerns that drive our industry.  As you review the information below, please note that each presenter's presentation is available within the conference booklet found within our website.

*** Must be a member to view handouts. Members click here to download conference booklet. You will first need to sign in.

Become a NAMSAP Member!  

Join NAMSAP Today! Founded in 2005, NAMSAP is the only non-profit association exclusively addressing current issues and challenges of Medicare Set-Aside arrangements. Through the voluntary efforts of our members, NAMSAP is a forum for the exchange of ideas and the leading resource for information on Medicare Set-Aside specific news. Members share the same dedication to promoting and advancing the highest standards and practices of this unique industry.
 

Primary Payers Appeals - How to Navigate Recent Rulemaking - Claims Office Fundamentals
By: Rita Wilson, Esq. 
      CEO, Tower MSA Partners, LLC
 
This session provided a 'best practices' overview as to how primary payers can navigate recent rulemaking to pursue conditional payment appeals, identified the cases to which this process is best applied and delivered a 'common sense' guide to claims offices to mitigate exposure at settlement time.  The panel included Melissa Woitalewicz, Crete Carrier Corporation, Deborah Robinson Stewart, JD, Genex Services, LLC and Kim Young, JD, Burns White. 

Click Here to read the entire article.
WCMSA Re-Review Process

By: Kimberly A. Wiswell, CMSP 

     Director of Operations, MEDVAL 

This session covered the grounds for appealing unfavorable decisions and tips to succeed in making your case. The panel included Carmen Folluo, RN/BSN, National Medicare Services Manager, CorVel; Shannon Metcalf, JD, Partner, Hedrick Gardner Kincheloe & Garofalo; and Kimberly Wiswell, CMSP, Vice President, MEDVAL.

The session began with an overview of the CMS re-review request process, describing how a re-review might be accomplished via the portal. This was followed by advice regarding the possibility of the submission of hard copy documentation for situations in which the portal would be unlikely to accept a re-review request, such as a new submitter's having taken over the submission/approval process for the claim. Further discussion here included an overview as to what materials were needed to support the re-review request, requirements regarding the creation date of any newly submitted documents and the types of documentation that might prove the most successful.

Click Here to read the entire article.
Submission vs Non-Submission (Opt-out)
By: Rasa Fumagalli JD, MSCC
      Director of Compliance, NuQuest
 
The pros and cons of CMS review were debated by a diverse panel of experts during the second day of the conference.  The panel included attorneys Robert Sagrillo, President and Chief Legal Officer of NuQuest, Jennifer Jordan, Chief Legal Officer and founder of MedVal and John Cattie, Jr, head of the MSP compliance group for the Garretson Resolution Group.   Rita Wilson, CEO of Tower MSA Partners, Melinda R. Petit, Director of Claims Operations at Chesapeake Employers Insurance Group and Mark Sidney, VP of Claims at Midwest Employers Casualty Company balanced the panel out. Mark Walls, VP of Communications and Strategic Analysis at Safety National, kept the audience engaged with his questions.
(Rear Admiral Schweitzer addresses the Surgeon General's Turn the Tide Campaign over Skype)


The session began with an overview of CMS' guidance on submission and the oftentimes inaccurate interpretation of the guidance by workers' compensation judges in certain jurisdictions such as Maryland and Nebraska. One of the main reasons cited for CMS submission in those jurisdictions and a few others was that "the judges make you do it". Proposed solutions included the parties challenging the workers' compensation judges' authority to push for submission as well as increased efforts by the industry to provide accurate MSP compliance training for the judges in the affected jurisdictions.

Click Here to read the entire article.
Thoughts on Medicare Advantage Panel Discussion at NAMSAP

By: Roy Franco, 
      Chief Client Legal Officer
In early September, the National Association of Medicare Set Aside Professionals (NAMSAP) held their annual conference in San Antonio, Texas. Personally, I was quite excited about the meeting and decided to attend because Judge Lee Yeakel, Judge, U.S. District Court (TX, Western District) would be speaking. It is rare to hear from a Judge sitting on the Federal bench about his insights on Medicare Secondary Payer (MSP) law. As Judge Yeakel decided the Humana vs Farmer's Ins. Exchange case, further illumination on Medicare Advantage Plan (MAP) rights was expected. I came away with several important insights for the industry to consider when considering a MSP case before the Federal courts.

(L to R - Ciara Kobe , Burns White, Lee Yeakel, Judge US District Court, Western District Texas, Jennifer Jordan, MEDVAL and Heather Sanderson,
Franco Signor LLC) **

 
First, give thought to the record and whether it covers all aspects to be raised for a judicial determination. His Honor mentioned that activist Judges are disfavored and he can only apply the law to the facts presented. He is not allowed to make an independent investigation. 
 

Click Here to read the entire article.
Liability Medicare Set-Asides

By: Mark Walls,
       Vice President Communications and Strategic Analysis 


At the 2016 NAMSAP Annual Conference, a panel provided an overview of how CMS is handling liability Medicare set-aside arrangements. The panel was:
  • David Cherry - Cherry Injury Firm
  • Roy Franco - Franco Signor, LLC
  • Thomas Spratt - NuQuest
There are significant differences between workers' compensation and liability Medicare set-asides. Workers' compensation benefits are statutory and often includes potential exposure for lifetime medical treatment. Liability coverage can be mitigated by contributory negligence, and it is ultimately subject to the policy limits.
(L to R -David Cherry, Cherry Injury Firm, Thomas Spratt, NuQuest and Roy Franco, Franco Signor LLC) **
 
Another challenge in the liability allocation is the concept of equity; whether the claimant was "made whole" by the settlement. If the claimant only recovered a small percentage of their damages, should CMS be entitled to a lien on that entire amount for an allocation or should their interests be reduced? This is an issue that has been debated in the courts.
 
 


Click Here to read the entire article.
Committee News

(Click the committee title to read report)



NAMSAP 2016 Annual Meeting and Educational Conference

Thanks to all who attended and made it a great success!!
  ** Special thanks to Mark Walls for use of his Annual Meeting and
Educational Conference photographs!

Paul Hiller joins NAMSAP with significant association management experience in meetings, membership, committee management and education program development. In Paul's decade long run with the Orthopaedic Trauma Association, his marketing focus grew the membership from 800 to over 2,000 and its annual meeting attendance for nine consecutive years. Paul earned his Certified Meeting Professional designation in 2014 and served on the Medical Meetings Task Force of the Professional Convention and Meetings Association in 2015. Paul is excited to bring his talents to NAMSAP to help the organization achieve it mission and vision. He can be reached at Paul@namsap.org or 630-617-5047.

The Communications Committee would like to encourage you to submit an industry-related article for our upcoming newsletters. We are accepting submissions in the following categories: Legal, Legislative, and Medical. If you are interested in contributing to one of these categories, or have an idea for a new category, please contact Rita Wilson, Communications Committee Chair. She can be reached by email at Rita.Wilson@TowerMSA.com.

Click here for past newsletter editions!