What are . . . medicare and medicaid secondary payer laws /
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| Author / Creator: | D'Aquilla, Nicholas, author. |
|---|---|
| Imprint: | Chicago, Illinos : American Bar Association, 2016. |
| Description: | viii, 164 pages : illustrations ; ǂc 23 cm |
| Language: | English |
| Subject: | |
| Format: | Print Book |
| URL for this record: | http://pi.lib.uchicago.edu/1001/cat/bib/10904381 |
Table of Contents:
- About the Authors
- 1. Medicare and the Medicare Secondary Payer Act
- 1.1. Introduction
- 1.2. Background on the Medicare Program
- 1.3. 42 U.S.C. § 1395y(b), the Medicare Secondary Payer Act
- 1.4. Intersection of Medicare Liens and "Other" Healthcare-Related Liens
- 2. Medicare's Recovery Rights under the MSP Act
- 2.1. Conditional Payments and Medicare's Recovery Right
- 2.2. Triggering a Medicare "Lien"
- 2.3. Scope of Medicare's Recovery Claim
- 2.4. The MSP Recovery Process: Start to Finish
- 2.5. Administrative Recourse
- 2.6. MSP Enforcement Mechanisms
- 2.7. Special Topics and Considerations
- 3. Medicare Advantage (Part C) Plans and the MSP Act
- 3.1. Introduction
- 3.2. Medicare Part C
- 3.3. In re Avandia
- 3.4. Jurisprudential Developments post-Avandia
- 3.5. Resolving MA Liens
- 3.6. Medicare Program Parts
- 4. Protecting Medicare's Future Interests
- 4.1. Introduction
- 4.2. The Current Statutory Framework
- 4.3. The Current Regulatory Framework
- 4.4. Administrative Guidance
- 4.5. Workers' Compensation Cases
- 4.6. Liability Insurance and Non-Workers' Compensation Cases
- 5. Protecting Medicare's Future Interests in Liability Cases
- 5.1. Four-Step Process
- 5.2. Step One: Are Future Medical Expenses a Part of the Claim or Settlement?
- 5.3. Step Two: Have Future Medical Expenses Been Funded?
- 5.4. Step Three: In What Amount Have Future Medical Expenses Been Funded?
- 5.5. Step Four: Prevent Inappropriate Billing
- 6. Fundamentals of IYIMSEA Section 111 Reporting
- 6.1. Overview
- 6.2. Who Must Report?
- 6.3. What Triggers Reporting Obligations?
- 6.4. What Data Is Reported and When?
- 6.5. How is Data Reported?
- 6.6. Conclusion
- 7. Medicaid and Medicaid Secondary Payer Laws
- 7.1. Introduction
- 7.2. The Medicaid Program
- 7.3. Medicaid Secondary Payer Laws
- 7.4. The Federal Medicaid Anti-Lien Statute
- 8. Ahlborn: The Anti-lien Statute and Medicaid Secondary Payer Laws
- 8.1. Background and Case History
- 8.2. Arkansas' Medicaid Secondary Payer Statute
- 8.3. Examination of the Federal Medicaid Secondary Payer Statutes
- 8.4. The Federal Medicaid Anti-Lien Statute
- 8.5. Settlements as Property
- 8.6. Other Concerns
- 8.7. Key Takeaways from Ahlborn
- 9. Wos: The Court Affirms and Elaborates on Ahlborn
- 9.1. Introduction
- 9.2. History and Case Background
- 9.3. North Carolina's Secondary Payer Statute
- 9.4. The Wos Ruling
- 9.5. Allocation is the Key
- 9.6. Key Takeaways from Wos
- 10. Legislative Response to Ahlborn and Wos
- 10.1. Legislative Action
- 10.2. The Current State
- 11. Examination of a State Medicaid Secondary Payer Law
- 11.1. Introduction
- 11.2. Louisiana's Medicaid Secondary Payer Statutes
- 11.3. Takeaways
- 12. Rise and Proliferation of Medicaid Managed Care
- 12.1. Medicaid Managed Care
- 12.2. MCOs and Medicaid Lien Recovery
- 12.3. The Intricacies of MMC
- 12.4. Conclusion
- 13. Other Considerations
- 13.1. Plaintiff-Beneficiary Benefit Preservation
- 13.2. Medicaid Estate Recovery
- 14. Resolving Medicaid Liens
- 14.1. Start the Process Early
- 14.2. Identify Plaintiff-Beneficiaries
- 14.3. Comply with Notice and Reporting Requirements
- 14.4. Analyze the State Statutory Framework
- 14.5. Review and Audit Lien Claims
- 14.6. Remember Ahlborn and Wos
- 14.7. Pay Liens and Document File
- Appendix A. Medicaid Secondary Payer Notice Obligations: State Examination
- Index
