Casualty Actuarial Society

2013 Casualty Loss Reserve Seminar

Reserving for Medicare Set-Asides

Tuesday, September 17, 2013: 1:00 p.m.
Clarendon Room (Boston Marriott Copley Place)
The Medicare Secondary Payer (MSP) Act is constantly changing and impacting the industry with new regulations, guidelines, and clarifications. With the January 10thsigning of the Strengthening Medicare and Repaying Taxpayers Act (SMART Act), implications for the workers’ compensation industry are further undetermined. Questions about how CMS will implement recent reforms and decisions by CMS on the application of AWP vs. claim pricing, off-label drugs, weaning of acute medications and inclusion of denied or non-compensable injuries remain unanswered.

The Medicare Set-Aside (MSA) process—which allocates funds for future medicals for Medicare beneficiaries—remains strife with operational challenges that include long delays for CMS and contractors to review and approve an MSA, no formal appeals process, and a general lack of response by CMS.  As a result, medical paid severities are increasing, claims are remaining open longer, and payers’ pending case inventories are growing at a time when payrolls have declined, the market is soft, and interest rates are miniscule.

This presentation will first examine the major issues impacting and complicating the Medicare Secondary Payer Act process, the possibility for potential change, and the associated expected outcomes. 

The MSA process also brings a challenge to actuaries who have to reserve for these claims. The second part of this presentation will explore various methods that companies are using to account for these future payments.

Moderator: Joshua Youdovin, Vice President, Conning


Presentation 1
Jeff Gurtcheff, Vice President and General Manager, PMSI
  • MSA - PMSI - Upload v1.pdf (1.7 MB)
  • Presentation 2
    Robert Miccolis, Director, Deloitte Consulting LLP
    Presentation 3
    Timothy Wisecarver, President, PA & DE Compensation Rating Bureaus
  • CLRS_091713 v4.pdf (90.8 kB)
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