Medicare As Secondary Payer - Section 111 Regulations
Teresa Long | Institute of WorkComp Professionals
Asheville, NC (CompNewsNetwork) - One of the hottest topics in Workers' Compensation is the impact of Medicare on Workers' Compensation settlements and the new reporting requirements of Section 111.
When a Workers' Compensation claim is settled and certain thresholds are met, consideration of the Medicare Secondary Payer Statute is required. The federal government is intensifying its efforts to make sure that all other benefit programs are paying their share of medical costs.
Medicare Section 111 new reporting requirements for insurance carriers, self-insured employers and any employer in a captive insurance product require Medicare notification for all bodily injury claims (including Workers' Compensation, general liability BI, auto bodily injury, product liability bodily injury and property medical payment claims). The failure to report can result in the denial of future Medicare payments to the claimant, as well as significant penalties.
If the recipient does not pay, Medicare can look to insurers or third party administrators for payment. To ensure that the recipient pays Medicare, particular care must be taken when drafting Workers' Comp settlement agreements with set asides.
Teresa A. Long is Director of Agency Services for the Institute of WorkComp Professionals in Asheville, NC, the largest network of Workers' Compensation professionals in the nation. Teresa was claims manager for 14 years for Walt Disney World and later was Vice President of Risk Management for Sarasota, FL-based Unisource Administrators, Inc. She can be contacted at 828-274-0959 and email@example.com, www.workcompprofessionals.com
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