Today’s post comes from guest author Leila A. Early from The Jernigan Law Firm.
Medicare should not pay medical bills that are the primary responsibility of a third party. When they do, they want to be reimbursed, and all parties understand that concept, but the problem is the lengthy delays and lack of due process. The SMART Act, which was signed into law by President Obama on January 10, 2013, amends and reforms the Medicare Secondary Payer Act to improve the reimbursement process. It is located in Title II of H.R. 1845 and entitled “Strengthening Medicare Secondary Payer Rules.”
Section 201 requires CMS to maintain a secure web portal with access to claims and reimbursement information. Payments for care made by CMS must be loaded onto the portal within 15 days of the payment being made. The portal must also provide supplier or provider names, diagnosis codes, dates or service, and conditional payment amounts. Moreover, the portal must accurately identify that a claim or payment is related to a potential settlement, judgment or award. After several steps, the parties may download a final conditional payment amount from the website. If there is a dispute over the conditional payment amount, CMS must respond/resolve the dispute within 11 days or the proposed resolution by the claimant/applicable plan will be deemed accepted. In terms of appeals, CMS must draft regulations that give applicable insurance plans limited appeal rights to challenge final conditional payment amounts. This process will go into effect around April of 2013.
Section 202 states that by November 15th of each year (beginning in 2014), CMS is required to calculate and publish a threshold for liability claims. If an amount owed is under that threshold amount, CMS is barred from seeking repayment. Section 205 states the statute of limitations for conditional payment recovery by CMS is three years after the receipt of notice of a settlement, judgment, award, or other payment made.
The SMART Act applies to workers’ compensation cases, so it is important to understand the law and how it will be applied in the future. Read it and follow its implementation closely.
Today’s post comes from guest author Brianne Rohner from Rehm, Bennett & Moore.
Every profession has certain turns of phrase or acronyms they use on a daily basis that, to the layperson, mean very little and may only serve to add confusion to an already difficult issue. The legal profession and the representation of injured workers is no different. Injured workers often find themselves traveling down a confusing road armed only with directions written in an unfamiliar or foreign-sounding language. The experienced attorneys at our firm navigate clients down this road on a daily basis.
Below is a list of commonly used acronyms to assist in understanding what is happening with your workers’ compensation case when everyone around you is suddenly speaking another language. Please keep in mind that the accompanying definitions are very general, and you should seek the advice of an experienced workers’ compensation attorney for more information or assistance with your case. Please also see the links for other blog posts for more information on some of these issues.
TPD stands for Temporary Partial Disability. TPD benefits are paid at a rate of 2/3 of the difference between your earning power before your injury and your earning power after. A typical example of a situation involving TPD is when your doctor restricts the number of hours you may work per day or per week. Another common example is payment for missed time while undergoing physical therapy or medical treatment.
PTD stands for Permanent Total Disability. PTD benefits are paid at a rate of 2/3 of your average weekly wage or wages for a minimum 40-hour week (this may depend on how you are paid), whichever is higher, for as long as you remain disabled. Generally, PTD is paid when, because of an injury, you cannot earn wages in the same kind or similar work for which you have been trained or are accustomed to performing, or any other kind of work that a person of your mentality and attainments could do. This previous blog post adds details to how PTD works: http://workerscompensationwatch.com/2013/02/average-weekly-wage-decides-workers-comp-benefits/
PPD stands for Permanent Partial Disability. PPD benefits are paid at a rate of 2/3 of your average weekly wage or wages for a minimum 40-hour week (this may depend on how you are paid), whichever is higher. PPD is either paid to compensate you for a loss of earning capacity (see definition below) or for a percentage of impairment sustained to a particular body part, which is usually assigned by your doctor. This previous blog post adds details to how PPD works: http://workerscompensationwatch.com/2012/01/four-things-you-should-know-about-carpal-tunnel-syndrome/
MMI stands for Maximum Medical Improvement. MMI is generally the point at which your injury will not get any better or worse, and your condition is essentially fixed. Typically, your doctor determines when this point is reached. This is also the point where temporary benefits end and permanent benefits begin.
While receiving medical treatment related to a workers’ compensation case, claimants often have additional expenses such as mileage, fuel costs, transportation fares, and out-of-pocket prescriptions. Yet many claimants don’t realize they are entitled to reimbursement for expenses they incur in obtaining treatment.
Submitting information related to these expenses is an important part of the workers’ compensation process. Problems can arise, however, when incomplete or disorganized information is provided to an insurance carrier. This can result in delays and errors in receiving the proper amount to which they are entitled.
Claimants can avoid these sorts of problems with small acts of diligence and record keeping. Here are a few suggestions:
• Save your receipts and keep a record of your doctor visits. Keeping a log and saving receipts incurred from specific doctor visits provides a “narrative” that makes it easier to tie together dates and expenses.