PPT-Medicare’s Interest in Workers’ Compensation Cases

PRESENTER Jonella Windell Medicare Secondary Payer Coordinator Seattle Regional Office 1 Medicare Secondary Payer Statute Section 1862b2 of the Social Security Act 42 USC 1395yb2 . How big is the problem?. What exactly is the problem?. Why is the problem important?. What can . be done to combat it?. The Griffith. Insurance Education Foundation. Cost of Insurance Fraud. The amount of workers compensation claims paid out annually is $60.2 billion. Montana was one of the first states in the country to enact workers’ compensation legislation.. Codified at Mont. Code Ann. § 39-71-101, et seq.. 39-71-105. Declaration of public policy.. (1) An objective of the Montana workers’ compensation system is to provide, without regard to fault, wage-loss and medical benefits to a worker suffering from a work-related injury or disease. Wage loss benefits are not intended to make an injured worker whole but are intended to assist a worker at a reasonable cost to the employer. . 2 Workers’programprovides treatment,replacement, sufferjob-related provides resultinjuredreceive regardless suffering Workers’responsible Workers’ et seq. • ensuringreceive James Lynch, Chief Actuary . Insurance Information Institute .  . 110 William Street .  . New York, NY 10038 . 212.346.5533 .  jamesl. @iii.org .  . www.iii.org. I.I.I. Mission Statement. Donald Patrick Eckler. Pretzel & Stouffer, Chartered. One South . Wacker. Suite 2500. Chicago, IL 60606. 312-578-7653. The Tripartite Relationship. “[The] so-called tripartite relationship has been well documented as a source of unending ethical, legal, and economic tension.” . Workers’ Compensation Fundamentals & Coverage Requirements October 30, 2018 Presented by Vivian R. Lane & Suzanne Soule 1 Agenda Workers’ Compensation – Fundamentals Covered Injuries and Claims Medicare Advantage and Other Medicare Health Plans WA SHIBA Version - Updated November 2018 Contents Lesson 1 —Medicare Advantage (MA) Plan Overview……………………………. Lesson 2 —Other Medicare Health Plans……………………………………………….. The Good, the Bad, and the Ugly: The Cooperation Clause, Medicare Secondary Payer Requirements, and the Tripartite Relationship Donald Patrick Eckler Pretzel & Stouffer, Chartered One South Wacker If you have investments will it affect your Medicare coverage? Find out here what will and won\'t reduce coverage. Find out what should know before applying for Medicare, learn all the Medicare application processes Ramón Castellblanch. . Professor Emeritus, Public Health. San Francisco State. December 2, 2021. Private Insurers’ Impact on Medicare. Profit-taking . Not risk-taking as claimed . Not coordinating care as claimed . Projected enrollment rates are calculated from CBO projections of Medicare Advantage enrollment and Part A eligibility (July 2021). 2021 Edition of Centers for Medicare and Medicaid Services . Statistical Supplement for 1990–2009 data. Wisconsin SHIP: 1-800-242-1060. Grant Funding Disclaimer. 2. This project was supported by the Wisconsin Department of Health Services with financial assistance, in whole or in part, by grant number 90SAPG0091, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects with government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official ACL policy.. Figure . 7.1 . Sources of prescription drug coverage in Medicare enrollees, by population, 2014. 2016 Annual Data Report, Vol 1, CKD, Ch . 7. 2. a The . catastrophic coverage amount is the greater of 5% of medication cost or the values shown in the chart above. In 2014, beneficiaries were charged $2.55 for those generic or preferred multisource drugs with a retail price less than $51 and 5% for those with a retail price over $51. For brand name drugs, beneficiaries paid $6.35 for those drugs with a retail price less than $127 and 5% for those with a retail price over $127. Table adapted from http://www.q1medicare.com/PartD-The-2014-Medicare-Part-D-Outlook.php. .