Louisiana Association of Self Insured Employers

I recently attended a certification course for professional Medicare Secondary Payer Professionals.  The course was held at the Loews Hotel in New Orleans.  It was entitled "Certified Medicare Secondary Payer Professional Certification Course" and it was sponsored by the Louisiana Association of Self Insured Employers.  This is a national certification program that is administered through the National Alliance for Medicare Set Aside Professionals (NAMSAP).  I was there for the refresher course as I attended the same program last year around this time and obtained a certification designated as the "Certified Medicare Secondary Payer Professional."  I attended this seminar to obtain updated information and to obtain my continuing education units to maintain that certification.

The program was well attended.  There were a great variety of people from various occupations related to the Medicare Secondary Payer Act who were in attendance including: plaintiff attorneys, defense attorneys, structured settlement brokers, nurse case managers, vocational rehabilitation consultants, third party administrators and several others.

The hotel was very nice and the facilities very accommodating.  The food was good as well.  Many of the same speakers that spoke last year also spoke this year and they were excellent.

The field of Medicare Secondary Payer Professionals is evolving as the activities surrounding the protection of Medicare's interests in workers compensation claim settlements has become more and increasingly complex.  On day one, several topics were addressed including: the history and development of the Medicare Secondary Payer Act, specialty claims, a discussion of the various CMS memos over the years, the structure of CMS and the role of the various individuals involved, the basics of structured settlements and Medicare set-aside allocations, and Medicare set-aside allocation administration and custodial accounts.  I noticed that since last year, there have been an increasing number of cases that have litigated in court that have established case law precedents.  The seminar reviewed some of the more important decisions.

Basically, Medicare is a secondary payer to many kinds of insurances including homeowners insurance, product liability insurance, general casualty insurance, malpractice liability insurance, automobile liability insurance, uninsured motorist liability insurance and underinsured motorist liability insurance.  And as such, when settlements occur within these types of insurances, which involve the possibility of injury-related future medical benefits, Medicare's interests must be considered and protected.  Although Medicare's emphasis has been primarily on workers compensation claim settlements, there is an increasing trend toward enforcement with regard to future medical costs and conditional payment recovery associated with liability claims as well.  The Medicare Secondary Payer Act provides that in all injury settlement situations that Medicare has a right to recover the full amount of conditional medical payments that have been made on those claims and that their interests must be protected against future medical claims.  The Center for Medicare and Medicaid services (i.e. CMS) regards the Medicare set-aside allocation as the best vehicle for protecting their interests.

I have found that membership in NAMSAP, particularly their listserv can be very helpful if you have questions pertaining to Medicare Conditional Payment Recovery, Drug Pricing, DME and Inclusion/Exclusion of various items in Medicare Set-Aside Allocations.  There are a lot of people on that listserv including nurse case managers, Medicare set-aside allocator consultants and attorneys that have a lot of experience that I am sure would be able to help to answer your questions about Medicare processes and Medicare set-asides.

At Thomas E Bott and Associates Incorporated, we have 3 consultants including me that are certified to prepare Medicare Set-Aside Allocations.  Additionally, we have affiliations with nurses that have had extensive experience in catastrophic case management, the understanding of complex diagnoses, treatments and medications as well as experiences with probable medical outcomes of a variety of medical conditions.

I am most certainly happy to consult with anyone who would have any questions that I would be able to answer concerning the current state of the art with regard to Medicare Set-Aside Allocations and CMS trends.  I received a big binder from the CMSPP course that I attended that is current as of September 2011.  You can also reach me at our contact numbers or you can feel free to e-mail me at tom@bottrehab.com.

Tom Bott