Medicaid & Medicareparalegals.utahbar.org/.../medicare-presentation.pdf · Medicaid & Medicare...
Transcript of Medicaid & Medicareparalegals.utahbar.org/.../medicare-presentation.pdf · Medicaid & Medicare...
![Page 1: Medicaid & Medicareparalegals.utahbar.org/.../medicare-presentation.pdf · Medicaid & Medicare Practice Tips Eisenberg, Gilchrist & Cutt. Candace Gleed. Damian Huntsman (801) 366-9100.](https://reader033.fdocuments.in/reader033/viewer/2022052007/601b5283bb42463bff1b3452/html5/thumbnails/1.jpg)
Medicaid & MedicarePractice Tips
Eisenberg, Gilchrist & CuttCandace Gleed
Damian Huntsman(801) 366-9100
www.egclegal.com
![Page 2: Medicaid & Medicareparalegals.utahbar.org/.../medicare-presentation.pdf · Medicaid & Medicare Practice Tips Eisenberg, Gilchrist & Cutt. Candace Gleed. Damian Huntsman (801) 366-9100.](https://reader033.fdocuments.in/reader033/viewer/2022052007/601b5283bb42463bff1b3452/html5/thumbnails/2.jpg)
Medicaid
• Insurance provided by the State of Utah• Financial need / disability / low-income
• Statutory requirement to notify of any Third Party Liability• Medicaid – Initial Notification
• Name• Date of Birth• Medicaid Insured Number• Attorney Information• Date of Injury / Loss • Short description of injury / claim• Responsible party
![Page 3: Medicaid & Medicareparalegals.utahbar.org/.../medicare-presentation.pdf · Medicaid & Medicare Practice Tips Eisenberg, Gilchrist & Cutt. Candace Gleed. Damian Huntsman (801) 366-9100.](https://reader033.fdocuments.in/reader033/viewer/2022052007/601b5283bb42463bff1b3452/html5/thumbnails/3.jpg)
Medicaid Cont.
• Collection Agreement for signature by attorney, injured party• Letter containing adjuster information• Ledger of claimed Lien / Subrogation• Requests for periodic updates for ongoing care by client• Mediation / Settlement
![Page 4: Medicaid & Medicareparalegals.utahbar.org/.../medicare-presentation.pdf · Medicaid & Medicare Practice Tips Eisenberg, Gilchrist & Cutt. Candace Gleed. Damian Huntsman (801) 366-9100.](https://reader033.fdocuments.in/reader033/viewer/2022052007/601b5283bb42463bff1b3452/html5/thumbnails/4.jpg)
![Page 5: Medicaid & Medicareparalegals.utahbar.org/.../medicare-presentation.pdf · Medicaid & Medicare Practice Tips Eisenberg, Gilchrist & Cutt. Candace Gleed. Damian Huntsman (801) 366-9100.](https://reader033.fdocuments.in/reader033/viewer/2022052007/601b5283bb42463bff1b3452/html5/thumbnails/5.jpg)
First Initial Medicare Letter
![Page 6: Medicaid & Medicareparalegals.utahbar.org/.../medicare-presentation.pdf · Medicaid & Medicare Practice Tips Eisenberg, Gilchrist & Cutt. Candace Gleed. Damian Huntsman (801) 366-9100.](https://reader033.fdocuments.in/reader033/viewer/2022052007/601b5283bb42463bff1b3452/html5/thumbnails/6.jpg)
MedicareImportant Facts
• Medicare Parts A, B, C, D (and gap insurance for international coverage)
• Part A –Covers hospital, home health, long-term care• Part B – Covers everything else, physician charges, PT, DME, etc.
• Administered by CMS – BRBC• Part C – Supp Insurance cover co-pays, deductibles, etc.• Part D – Pharmacy
• Administered by private insurance companies
• All programs require reimbursement and notification• 42 CFR 411.24
![Page 7: Medicaid & Medicareparalegals.utahbar.org/.../medicare-presentation.pdf · Medicaid & Medicare Practice Tips Eisenberg, Gilchrist & Cutt. Candace Gleed. Damian Huntsman (801) 366-9100.](https://reader033.fdocuments.in/reader033/viewer/2022052007/601b5283bb42463bff1b3452/html5/thumbnails/7.jpg)
3 Types of Cases for Reporting
• Liability• At-fault Liability Claims / Policies• Underinsured Claims / Policies• Uninsured Claims / Policies
• No-Fault Insurance• Personal Injury Protection• Med Pay
• Worker’s Compensation
![Page 8: Medicaid & Medicareparalegals.utahbar.org/.../medicare-presentation.pdf · Medicaid & Medicare Practice Tips Eisenberg, Gilchrist & Cutt. Candace Gleed. Damian Huntsman (801) 366-9100.](https://reader033.fdocuments.in/reader033/viewer/2022052007/601b5283bb42463bff1b3452/html5/thumbnails/8.jpg)
Plaintiff / Defense
• Section 111 Requires Reporting by Insurance Payers• Current $750 threshold to report• Penalties for non-reported cases $1,000 per day per violation
• Requires ICD-9 and ICD-10 codes on the report• Defense required reporting of PIP / medpay claims• Not available to Plaintiffs or beneficiary unless a release is signed• Can affect payment of claims relating to injury• Beneficial for Plaintiffs to review codes / req from adjuster or defense
![Page 9: Medicaid & Medicareparalegals.utahbar.org/.../medicare-presentation.pdf · Medicaid & Medicare Practice Tips Eisenberg, Gilchrist & Cutt. Candace Gleed. Damian Huntsman (801) 366-9100.](https://reader033.fdocuments.in/reader033/viewer/2022052007/601b5283bb42463bff1b3452/html5/thumbnails/9.jpg)
Conditional Payments
• BRBC • Liability cases• Plaintiff / Beneficiary• Primarily Liability and Workers Compensation cases
• CRC• No-fault cases• Insurance Payors / Defense
• Contractor with claim will handle all disputes, payments, etc.
![Page 10: Medicaid & Medicareparalegals.utahbar.org/.../medicare-presentation.pdf · Medicaid & Medicare Practice Tips Eisenberg, Gilchrist & Cutt. Candace Gleed. Damian Huntsman (801) 366-9100.](https://reader033.fdocuments.in/reader033/viewer/2022052007/601b5283bb42463bff1b3452/html5/thumbnails/10.jpg)
• Open only one case with Medicare for each applicable claim.
• If a claim for Liability / UIM run consecutive two cases are required to be open
• Use same language to describe injuries in correspondence, cover sheets, etc. to prevent confusion, duplicate cases opened, or unrelated charges being added to lien ledger
![Page 11: Medicaid & Medicareparalegals.utahbar.org/.../medicare-presentation.pdf · Medicaid & Medicare Practice Tips Eisenberg, Gilchrist & Cutt. Candace Gleed. Damian Huntsman (801) 366-9100.](https://reader033.fdocuments.in/reader033/viewer/2022052007/601b5283bb42463bff1b3452/html5/thumbnails/11.jpg)
CMS.gov Reporting Guidelines
![Page 12: Medicaid & Medicareparalegals.utahbar.org/.../medicare-presentation.pdf · Medicaid & Medicare Practice Tips Eisenberg, Gilchrist & Cutt. Candace Gleed. Damian Huntsman (801) 366-9100.](https://reader033.fdocuments.in/reader033/viewer/2022052007/601b5283bb42463bff1b3452/html5/thumbnails/12.jpg)
![Page 13: Medicaid & Medicareparalegals.utahbar.org/.../medicare-presentation.pdf · Medicaid & Medicare Practice Tips Eisenberg, Gilchrist & Cutt. Candace Gleed. Damian Huntsman (801) 366-9100.](https://reader033.fdocuments.in/reader033/viewer/2022052007/601b5283bb42463bff1b3452/html5/thumbnails/13.jpg)
![Page 14: Medicaid & Medicareparalegals.utahbar.org/.../medicare-presentation.pdf · Medicaid & Medicare Practice Tips Eisenberg, Gilchrist & Cutt. Candace Gleed. Damian Huntsman (801) 366-9100.](https://reader033.fdocuments.in/reader033/viewer/2022052007/601b5283bb42463bff1b3452/html5/thumbnails/14.jpg)
![Page 15: Medicaid & Medicareparalegals.utahbar.org/.../medicare-presentation.pdf · Medicaid & Medicare Practice Tips Eisenberg, Gilchrist & Cutt. Candace Gleed. Damian Huntsman (801) 366-9100.](https://reader033.fdocuments.in/reader033/viewer/2022052007/601b5283bb42463bff1b3452/html5/thumbnails/15.jpg)
Medicare – Letter / Notice of Case
![Page 16: Medicaid & Medicareparalegals.utahbar.org/.../medicare-presentation.pdf · Medicaid & Medicare Practice Tips Eisenberg, Gilchrist & Cutt. Candace Gleed. Damian Huntsman (801) 366-9100.](https://reader033.fdocuments.in/reader033/viewer/2022052007/601b5283bb42463bff1b3452/html5/thumbnails/16.jpg)
![Page 17: Medicaid & Medicareparalegals.utahbar.org/.../medicare-presentation.pdf · Medicaid & Medicare Practice Tips Eisenberg, Gilchrist & Cutt. Candace Gleed. Damian Huntsman (801) 366-9100.](https://reader033.fdocuments.in/reader033/viewer/2022052007/601b5283bb42463bff1b3452/html5/thumbnails/17.jpg)
![Page 18: Medicaid & Medicareparalegals.utahbar.org/.../medicare-presentation.pdf · Medicaid & Medicare Practice Tips Eisenberg, Gilchrist & Cutt. Candace Gleed. Damian Huntsman (801) 366-9100.](https://reader033.fdocuments.in/reader033/viewer/2022052007/601b5283bb42463bff1b3452/html5/thumbnails/18.jpg)
![Page 19: Medicaid & Medicareparalegals.utahbar.org/.../medicare-presentation.pdf · Medicaid & Medicare Practice Tips Eisenberg, Gilchrist & Cutt. Candace Gleed. Damian Huntsman (801) 366-9100.](https://reader033.fdocuments.in/reader033/viewer/2022052007/601b5283bb42463bff1b3452/html5/thumbnails/19.jpg)
MSPRP Features & Benefits
![Page 20: Medicaid & Medicareparalegals.utahbar.org/.../medicare-presentation.pdf · Medicaid & Medicare Practice Tips Eisenberg, Gilchrist & Cutt. Candace Gleed. Damian Huntsman (801) 366-9100.](https://reader033.fdocuments.in/reader033/viewer/2022052007/601b5283bb42463bff1b3452/html5/thumbnails/20.jpg)
![Page 21: Medicaid & Medicareparalegals.utahbar.org/.../medicare-presentation.pdf · Medicaid & Medicare Practice Tips Eisenberg, Gilchrist & Cutt. Candace Gleed. Damian Huntsman (801) 366-9100.](https://reader033.fdocuments.in/reader033/viewer/2022052007/601b5283bb42463bff1b3452/html5/thumbnails/21.jpg)
![Page 22: Medicaid & Medicareparalegals.utahbar.org/.../medicare-presentation.pdf · Medicaid & Medicare Practice Tips Eisenberg, Gilchrist & Cutt. Candace Gleed. Damian Huntsman (801) 366-9100.](https://reader033.fdocuments.in/reader033/viewer/2022052007/601b5283bb42463bff1b3452/html5/thumbnails/22.jpg)
![Page 23: Medicaid & Medicareparalegals.utahbar.org/.../medicare-presentation.pdf · Medicaid & Medicare Practice Tips Eisenberg, Gilchrist & Cutt. Candace Gleed. Damian Huntsman (801) 366-9100.](https://reader033.fdocuments.in/reader033/viewer/2022052007/601b5283bb42463bff1b3452/html5/thumbnails/23.jpg)
![Page 24: Medicaid & Medicareparalegals.utahbar.org/.../medicare-presentation.pdf · Medicaid & Medicare Practice Tips Eisenberg, Gilchrist & Cutt. Candace Gleed. Damian Huntsman (801) 366-9100.](https://reader033.fdocuments.in/reader033/viewer/2022052007/601b5283bb42463bff1b3452/html5/thumbnails/24.jpg)
![Page 25: Medicaid & Medicareparalegals.utahbar.org/.../medicare-presentation.pdf · Medicaid & Medicare Practice Tips Eisenberg, Gilchrist & Cutt. Candace Gleed. Damian Huntsman (801) 366-9100.](https://reader033.fdocuments.in/reader033/viewer/2022052007/601b5283bb42463bff1b3452/html5/thumbnails/25.jpg)
Final Demand
![Page 26: Medicaid & Medicareparalegals.utahbar.org/.../medicare-presentation.pdf · Medicaid & Medicare Practice Tips Eisenberg, Gilchrist & Cutt. Candace Gleed. Damian Huntsman (801) 366-9100.](https://reader033.fdocuments.in/reader033/viewer/2022052007/601b5283bb42463bff1b3452/html5/thumbnails/26.jpg)
![Page 27: Medicaid & Medicareparalegals.utahbar.org/.../medicare-presentation.pdf · Medicaid & Medicare Practice Tips Eisenberg, Gilchrist & Cutt. Candace Gleed. Damian Huntsman (801) 366-9100.](https://reader033.fdocuments.in/reader033/viewer/2022052007/601b5283bb42463bff1b3452/html5/thumbnails/27.jpg)