There were numerous questions from the floor with regard to the day to day effects of the Medicare/Medicaid legislation.
Ryon Hayward, of ServiceMaster Restoration (blue shirt) and Carmie Cindric, of Rochat & Smith Appraisers (next to Ryon) were among the crowd. Carmie was President on East Bay Adjusters Association in the late 1990s.
EBCA Vice President Steve Muir, of CSAA, ran the April door prize drawings.
Nice to see Sharon Glenn, of John Glenn Adjusters, amongst the crowd.
EBCA Rep to the CCNC, Lisa Winn, gave an update on progress for the September 10-11, 2009 event. Exhibit booth placements and sponsorship opportunities are now open to all. Educational program schedule will be forthcoming. Click for details.
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Controversy Inevitable Over the SCHIP Extension Act
By Kelly Sullivan
Crawford & Company
The room was abuzz with anticipation for Jim Price and Roy Franco’s informing and provocative presentation on the SCHIP Extension Act of 2007. With a turnout of over 100 people, the energy levels in the room were high and the topic was enticing enough to keep us all on the edge of our seats. In fact, there was so much to cover, we ran out of time.
The SCHIP Extension Act of 2007 requires liability insurers, including self-insurers, no- fault insurers and workers’ compensation insurers, to:
-Determine Medicare/Medicaid status for all claimants; and
-Report to the Centers for Medicare and Medicaid Services (“CMS”) when those claims are resolved.
Jim Price explained that this means it is the carrier’s duty to determine if the claimant is on Medicare first, then to report this to the appropriate agency, in the event a claim resolution is being sought. The reasoning behind this is, of course, money. Medicare spent $330 billion in benefits in 2005. Medicare’s recovery system was lacking and its expenditures increasing dramatically. Something had to be done...
Jim was a wealth of knowledge on this subject and we learned that the SCHIP Extension Act, however well-intended, appears to have some pitfalls. EBCA members yet to be exposed to the execution of this Act learned that even if there is little or no liability involved in a claim, but a payment is made in compromise, the statutory reporting requirement still exists. Moreover, there are fines! Fines of up to $1000 per day, per claimant, for failure to comply with the statute.
Further complicating matters is the fact that Medicare’s right to recover payments extends to the insurance carrier directly and not just the claimant. Essentially, anyone who has received medical care for which Medicare paid, then later receives payment from a “primary plan” (including a liability insurer, workers’ compensation carrier, or “self-insured entity”) must reimburse Medicare within 60 days of receiving payment or settlement. If they do not pay Medicare within this time frame, we were surprised to learn that the primary payer must also reimburse Medicare.
Jim also explained that Medicare’s right to reimbursement accrues when a primary plan pays an injured party for an expense for which Medicare initially paid, regardless of the reason the payment was made. As previously mentioned, nuisance claims, compromise payments, even MedPay coverage payments are considered a form of a liability insurance payment.
Another caveat; Medicare can recover 100% of their lien, regardless of whether a settlement was only for a portion of the medical treatment, such as in the instance of pre-existing or unrelated conditions.
As if the aforementioned wasn’t enough to get us going, Roy Franco’s contagious spark ignited the room when he took over the second half of the presentation and pointed out that;
-Medicare is under virtually no time constraint to make a final demand. It typically takes months, if not years sometimes, for Medicare representatives to calculate the amounts they are owed. This delay leaves the responsibility and the amount due an unanswered question.
-As previously described, Medicare’s right to reimbursement does not accrue until the settlement is paid. Consequently, Medicare does not participate in settlement negotiations. This is due, in part, because Medicare’s involvement does not even begin until after a settlement. This precludes parties from being able to negotiate with Medicare at all, and impairs their ability to utilize the claim to help settle their case. The lack of this option could potentially lead parties to decide they cannot resolve their claim, and if so, Medicare (and everyone) loses.
The clock was ticking as this topic continued to provoke much thought and discussion, but unfortunately, we had to conclude the presentation. For those of you with a heightened awareness but a desire to learn more, Roy Franco and Jim Price will be presenters at this years’ CCNC in Sacramento, CA.
It should come as no surprise that both Jim Price and Roy Franco are involved in the Medicare Advocacy Recovery Coalition, (MARC). In fact, Roy Franco the director of Risk Management Strategies, Safeway, Inc., is the Chairman of MARC.
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 2009 EBCA Golf Tournament Committee Chair Brian Davis, of Restoration Clean-Up Company, has put together quite the tournament experience for the group. He outlined details, including the option of a discounted hotel room for those who choose to stay in the Napa/American Canyon area. Click for details.
Congratulations to Keith Rogers, of Servpro of Concord/ Danville, who was the lucky winner of the 50/50 Raffle drawing.
Good to see both Thad Eaton (pictured above with wine winnings) and Dave Johnson, and Dave's son, of Eaton & Johnson independent adjusters at the April meeting.
Happy Birthday to EBCA Treasurer Kim Tamayo, or Restoration Management Co.
Very cute Easter-themed table decorations at April EBCA.
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