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1. Liability TPOC reporting delays Alert - The table in the Alert itself is the best summary available.

a. $100K, TPOC date on or after 10/1/11
b. $50K, TPOC date on or after 4/1/12
c. $25K, TPOC date on or after 7/1/12
d. minimum threshold, TPOC date on or after 10/1/12. Minimum thresholds are:

- ≤$5K, TPOC date prior to 1/1/13, exempt from reporting
- ≤$2K, TPOC date 1/1/13 to 12/31/13, exempt from reporting
- ≤$600, TPOC date 1/1/14 to 12/31/14, exempt from reporting

No threshold for claims where last TPOC date is 1/1/15 and subsequent.

2. Exposure, Ingestion, Implantation 12/5/80 Alert –

Essentially states that as long as all exposure/ingestion/implantation occurred pre-12/5/80 and nothing on or after 12/5/80 is claimed or released then CMS will not assert a recovery claim and reporting is not required. Allows an exception for a broad general release that effectively released exposure/ingestion on or after 12/5/80. Based on what I have heard on CMS calls, the RRE should be able to prove that despite the broad general release, the fact is that no exposure occurred on or after 12/5/80.

3. Qualified Settlement Funds Alert –

a. QSFs are NOT RREs
b. Limited Section 111 reporting exception if:

- There is a liability insurance TPOC with no ORM
- The TPOC is issued by a QSF under Section 468B of the IRC in connection with a bankruptcy; AND
- The funds being issued were paid into the trust prior to 10/1/11.

4. Future Medicals in Liability Settlements Alert –

This is significant mainly because it is the first written policy we have seen from CMS regarding LMSAs. CMS recognizes that if the treating physician provides written certification that all injury-related treatment has been completed as of the dated of settlement, then CMS’ position will be that Medicare’s interest with respect to future medicals has been satisfied. The certification need not be submitted to CMS and CMS will not provide a verification letter in response to a physician certification that treatment has concluded. CMS encourages that the beneficiary or their representative “maintain the physician’s certification.”

5. Coming Soon

1. MSPRC self-service phone service.
2. October 2011 Alert (by 10/21/11) re: liability cases ≤$5K having the option of paying a fixed percentage through the MSPRC.
3. MSPRC portal to allow online access to facilitate recovery process.
4. Option to allow for immediate payment for FUTURE medical claimed/released in a settlement.
5. Ability to obtain a conditional payment amount prior to settlement in some situations.

1. There are a lot of beneficiaries who are experiencing denials on unrelated claims. CMS isn’t taking much of a position but is lecturing that this is why accuracy of coding is so important. They are advising that the beneficiary should contact the COBC directly if claims are being inappropriately denied.
2. During Q&A someone asked whether rumors that liability reporting might be delayed beyond 10/1/11 were true. Barbara Wright responded that there have been several requests. CMS is considering those requests but no decision has been made.

Expect generic versions of Seroquel® to appear in Redbook® on 09/27/11, or very shortly thereafter.

“Now, more than ever, we depend on Inc. 500/5000 companies to spur innovation, provide jobs, and drive the economy forward. Growth companies, not large corporations, are where the action is,” says Inc. magazine Editor Jane Berentson.

MEDVAL President, Ryan Roth commented “We are honored to again receive this recognition for our ongoing growth. More importantly, our growth reflects a continuous focus on providing our customers the service and expertise they need to meet the challenge of compliance with complex Medicare Secondary Payer regulations.“

About MEDVAL, LLC

MEDVAL was the first firm in the nation to deliver a fully-integrated Medicare Secondary Payer (MSP) compliance solution. From initial Medicare Set-Aside evaluation to administration of MSA funds, MEDVAL serves attorneys, carriers, and TPAs seeking a better MSP compliance process for complex personal injury and workers’ compensation claims. More information is available at www.medval.com.

The foundation was created to provide much needed assistance to Medicare beneficiaries facing MSP compliance issues resulting from an insurance settlement. In addition to offering a variety of low or no cost education and advocacy services, the foundation proposes to offer a solution to the high cost of for-profit professional administration and the unworkable situation faced by injured beneficiaries attempting to self-administer their Medicare Set-Aside Arrangements. The MSPCF will provide all of the same services currently provided by for-profit administrators at no charge to qualified beneficiaries.

The MSPCF will retain MEDVAL, one of the country’s oldest and most trusted MSP compliance and professional administration firms, to service the individual sub trust accounts. MEDVAL has contractually committed to contribute significant financial and operational support over the next five years while the foundation gains critical mass and widespread industry acceptance.

“This is a solution that is long overdue. For-profit administration is underutilized because the service is far too expensive for Payers and Plaintiffs. Self-administration has proven to be a tremendous burden to injured beneficiaries and has not achieved the goal of protecting the Medicare Trust Fund. By taking the profit motive out of MSA administration, eliminating sales commissions, driving down operating costs through technology and seeking charitable partnerships and willing corporate sponsors of this new business model, I believe the MSPCF is poised to permanently shift the way MSA funds are administered,” commented Board of Trustee member and MEDVAL General Counsel Jennifer C. Jordan, Esq.

The Medicare Secondary Payer Charitable Foundation is independent of its sponsors and vendor neutral. Any CMS approved MSA over $25,000, from any vendor, payer, claimant or attorney, will be accepted for administration subject to the terms and conditions of the master trust and joinder agreements.

The Medicare Secondary Payer Charitable Foundation is a Maryland based not-for-profit corporation. For additional information, please email info@mspcf.org or visit www.mspcf.org.

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“Over the past two years, Caroline has demonstrated a strong work ethic, sound business judgment, technical competence and the ability to conceive and implement strategic initiatives,” commented MEDVAL’s President, Ryan Roth. “With this promotion, we now have a strong and complete management team in place to guide us to the next level of growth.”

Caroline received her Master of Business Administration degree from the Darden School of Business at the University of Virginia, where she earned the William Michael Shermet Award for Academic Excellence. She received her Bachelor of Science degree from Vanderbilt University. She is currently on the Community Advisory Board for WYPR, on the board of directors for the Maryland Steeplechase Association and is active in the support of the Family and Children Services of Central Maryland.

Media:

Baltimore Business Journal http://www.bizjournals.com/baltimore/potmsearch/detail/submission/80751

City Biz List http://www.bizjournals.com/baltimore/potmsearch/detail/submission/80751

With the addition of Part D to the Medicare program in 2006, Medicare set-aside allocations (“MSAs”) grew exponentially overnight… Read the complete post at the LexisNexis Workers’ Compensation Law Community.

The new letter format can be downloaded at: http://www.msprc.info/forms/RightsAndResponsibilitiesLetter.pdf