Casualty Actuarial Society

2014 Centennial Celebration and Annual Meeting

C-26
Medicare Secondary Payer Act

Wednesday, November 12, 2014: 8:00 a.m.
Clinton (New York Hilton Midtown)
Under Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (“the MMSEA”), liability insurers (including self-insureds), no-fault insurers, and workers compensation insurers are obligated to notify Medicare about claims involving ongoing medical treatment, settlements, judgments, awards, or other one-time and lump sum payments received by or on behalf of Medicare beneficiaries.  The reporting requirements for Section 111 concern Medicare beneficiaries who also are receiving medical treatment for a work-related injury or an injury where the incident was covered by a liability policy or self-insurance arrangement. In recent years, the Centers for Medicare & Medicaid Services (CMS) has used Section 111 to track Medicare’s secondary payer status: the reporting of claims has become more formalized and the financial thresholds for reporting these claims have decreased.  In this paper, we review the Section 111 reporting requirements that have implications for a practicing casualty actuary.  The panelists will present a general discussion of the potential impacts of Section 111 reporting on insurer and self-insured losses, and other potential financial impacts.  They will review the regulations and discuss the features of the Section 111 reporting requirements that have implications for a practicing casualty actuary.
Moderator: Glen Leibowitz, SVP, ACE Group

Speakers

Presentation 1
Christine Fleming, Claims Management Consultant, Milliman, Inc.
Presentation 2
Philip S. Borba, Principal, Senior Consultant, Milliman
Presentation 3
Guy Avagliano, Consulting Actuary, Milliman, Inc.
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