CMS started 2025 with a new WCMSA Reference Guide. Join us as we discuss the changes in version 4.2 of the Workers’ Compensation Medicare Set-Aside (WCMSA) Reference Guide. With CMS ending the ability to submit for future waivers in July, the team will discuss options for addressing these types of cases going forward. We will also discuss the change that CMS made to the Amended Review process immediately after the release of version 4.2 of the Guide.

Key takeaways:

• Review the changes CMS made to the WCMSA Reference Guide in version 4.2
• Examine options for handling future waiver cases after CMS stops reviewing them in July of 2025
• Discuss the CMS notice issued after the release of the latest WCMSA Reference Guide that changed Amended Review timing

Section 111 Reporting requirements and risks have continued to increase and evolve in the last two years.  An understanding of both is needed for a compliant reporting program.  We will review Workers’ Compensation Medicare Set-Aside Reporting as part of TPOC, the start of Section 111 Penalties, and User Guide changes and updates that impact you as well as best practices going forward. 

Key takeaways: 

• Discuss Section 111 developments and how they can impact your organization
• Review WCMSA reporting requirements and their potential impact on your MSA programs  
• Evaluate potential gaps in your reporting process and identify best practice

Join IMPAXX as we examine many of the reasons why an MSA and/or CMS approval may have included treatment for a denied condition and provide guidance on how to support the exclusion of a denied condition for a CMS submission. We will also review options for mitigating treatment and keeping costs within settlement range. 

Key takeaways: 

• Understand the difference between pre-existing and/or co-morbid conditions versus denied conditions  
• Discover the consequences of claim payment decisions on the MSA 
• Identify the impact of IMEs, treating physician opinions, and court orders on the outcome of a CMS submission as it relates to denied conditions 

Traditional Medicare has an automated process to search and collect conditional payments against carriers and self-insureds when Ongoing Responsibilities for Medicals (ORM) has been indicated. In the session we will discuss how failing to address Medicare’s conditional payments in this circumstance can lead to U.S. Treasury collection and unanticipated garnishment from the Federal Government.  

Key takeaways: 

• Learn about Medicare’s search and collection process when ORM has been reported  
• Review the steps of the administrative appeal process, U.S. Treasury collection and alternate options to appeal traditional Medicare conditional payments
• Discuss how federal funds can be withheld from a carrier/self-insured or how federal grants can be denied 

Join us as we kick off our Back to the Basics summer series. In this first session, we will review the foundations of MSP compliance including how best to remain compliant and minimize risk in the rapidly changing Medicare Secondary payer compliance landscape.
 

Key takeaways: 

• Get an overview of the purpose and parts of MSP compliance 
• Conduct an examination of when future allocations are appropriate and explore the various types of allocations  
• Discuss the steps you need to take after you receive your allocation/MSA report

The second webinar in our summer series focuses on Conditional Payments. Medicare may have paid for care before the beneficiary has obtained a settlement and these payments are referred to as “conditional payments” because Medicare pays under the condition that it will be reimbursed when the beneficiary gets a settlement. 

Key takeaways: 

• Gain a better understanding of the conditional payment process and what to do and look for in disputing conditional payments 
• Learn about the differences between Medicare’s recovery based on Ongoing Responsibility for Medical (ORM) and their searches based on settlement reporting  
• Explore which types of evidence can increase your chances of success

The final webinar in our summer series on the basics of Medicare Secondary Payer Compliance focuses on settlement. Settling claims can be difficult in general but working to settle claims with Medicare issues (or potential issues) can be even more challenging. Join us as we share insights for taking these issues head on.  

Key takeaways: 

• Identify Medicare Secondary Payer compliance issues that can impact settlements 
• Discuss options for mitigating your future allocation exposure 
• Identify which cases are the best fit for using annuities and administration options to help move settlements along

It’s time that time of the year again… settlement season.  Join us as we discuss overcoming obstacles to settlement on your difficult pending claims and how best to position your claims for settlement.

Key takeaways: 

• Consider how settlement projects can efficiently lower your overall pending numbers and review how to choose the best cases to include in the settlement project 
• Explore creative solutions to help you reach the settlement finish line including funding and administration options

Join IMPAXX to discuss development letters within the CMS submission process. We will provide guidance on how to understand the nature of CMS’ requests and how best to respond them. We will review examples of how IMPAXX has successfully resolved these situations, from the common to the unique.  

Key takeaways: 

• Gain a better understanding of the format and role of a CMS’ development letter and where to focus your attention  
• Get practice tips on how to identify if CMS is missing the basic information necessary for submission, or if they are looking for something more specific from their review  
• Discover the best options for moving your claim forward, including providing medical records, the role of clarification letters, and when to consider withdrawing your submission

Starting in December 2021, the PAID Act has required Medicare to provide carriers and self-insureds with a claimant’s Medicare Advantage and Prescription Drug Plan insurance information. Join us as we examine how Medicare Advantage and Prescription Drug plans are now under more pressure from Medicare to seek reimbursement from carrier/self-insureds through the Ongoing Responsibility for Medical (ORM) and Total Payment Obligation to Claimant (TPOC) reporting processes.  

Key takeaways: 

• Learn why identifying and resolving these potential liens is paramount (hint: Medicare Advantage Plans account for over 50% of Medicare enrollees) 
• Review Medicare’s query process and explore how this information can be used to minimize unanticipated liens and effectively resolve issues 

We have been talking about and preparing for them for years – but now is the time… Civil Money Penalties (CMPs) for Mandatory Insurer Reporting are here.  Join the IMPAXX team for a recap of the regulations and a discussion the steps you can take now to help avoid the need to manage a penalty situation. 

Key takeaways: 

• Recap the Final Rule for CMPs, which focus on timely acceptance of ORM and timely reporting of settlements (TPOC)  
• Review the audit and appeals processes and tiered penalty format 
• Identify best practices to avoid CMPs and ways to confirm you are compliant with Section 111 reporting requirements 

Join IMPAXX as we look back on the major MSP compliance news (and trends) of 2024 and offer tips and insights about what’s to come in 2025. From the implementation of Section 111 Civil Monetary Penalties in the fall of 2024 and TPOC reporting requirements for Workers’ Compensation Medicare Set-Asides (WCMSAs) being introduced in April 2025 to Conditional Payment challenges and opportunities, we will explore solutions and share the resolutions you can make now to help mitigate your potential MSP exposure in 2025.

Key takeaways:

• Examine the Section 111 Civil Monetary Penalties Final Rule and delve into how its implementation may impact your organization
• Explore upcoming changes to TPOC reporting requirements for Workers’ Compensation Medicare Set-Asides (WCMSAs) how to confirm your reporting is accurate and timely
• Discuss what’s to come in 2025 regarding Section 111 Reporting, Conditional Payments, etc., including deadlines and milestones, and how you can be informed, reduce your risk, and stay ahead of your competition

Bridget Smith
Sr. VP, National Accounts
and Settlement Consulting

Jennifer Shymanski
Vice President,
Implementation and Strategy

Mark Heberling
Vice President,
Settlement Consulting

Patrick Czuprynski
Director,
Lien Resolution

Dawn Dietz
Assistant VP,
Settlement Consulting