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Third Party Liability MFWCCA Conference 2008 Duluth 10/08,09/2008 Benefit Recovery COB/TPL Jan Taylor, Manager Benefit Recovery Section DHS Health Care Operations Jan.email@example.com 651-431-3139 Benefit Recovery Section Responsible to ensure that MHCP is payer of last resort; all other resources must be used to fullest extent Partner with financial worker staff in many ways to gain information and fulfill responsibilities Important that clients understand their responsibilities about TPL Units within BRS Health Insurance Unit Tort Liability Unit MA Lien and Estate Recovery Unit Medicare Revenue Enhancement (LTC) See Handout Pg. 1—BRS Contact List Health Insurance Unit Maintain the TPL Resource File in MMIS – Reviewing county added TPL records (including those interfaced from PRISM) – Incoming faxes from medical providers— updates – Reviewing Possible Insurance Cases for unknown TPL See Handout—Attachment A Health Insurance Unit Bill health insurers for retro coverage --Processing TPL payments/denials Review & Approve Cost Effective Health Insurance policies File updates with data match results – Child support (daily) – Tricare (annually) – Other insurance carriers (current RFP) Medicare & LTC Insurance are TPL Regardless of where the payment of benefits is directed – LTC insurance must be coded as a policy in MMIS/TPL Resource – Providers of LTC services must bill and report receipt of payment on the claims submitted to MHCP Do Not Treat LTC Insurance Proceeds as Income/Assets If the policy is not specifically ―income replacement‖ it is TPL If benefits are payable as a result of home care services or NF services = TPL Client or personal rep must pay the benefits to the nursing home Coverage Types Expanded MMIS has new Coverage Types for the expanded benefits of LTC insurance – – – – 13—Nursing Home Only 27—Nursing Home + Home Care* 28—Nursing Home Only (Partnership Qualified)* 29—Nursing Home + Home Care (Partnership Qualified)* *New Coverage Types were Implemented February 2008; See LTCP Bulletin #08-21-08. Services Covered by Managed Care Organization (MCO) If SNF or Home Care services are covered by an MCO, LTC insurance benefits are payable to the MCO The LTC insurance payments must be reported on the claims submitted to the MCO The MCO is secondary to LTC insurance benefits New Initiatives for Improved Efficiency Quality improvement process (Lean/Kaizen) used for three major BRS processes County staff members participated in a short-term ―Focus Group‖ to review draft products and provide input Cost Effective Health Insurance Decision Tree (In Development) Decision Tree (State Agency Staff) ―Standard Work‖ Document in Use for BRS Staff Process Changes Identified CEHI Form is being revised (Draft) MMIS Request for ―Combo Screen‖ of data relevant to CE review Use of Fax for Future Requests and Workflow Changes State Plan Amendment to CMS See Handout—Attachment B Tort Liability Unit Pursues TPL Related to Accidents/Injuries --Grant money may be part of BRS Claim ―Leads‖ to Cases – Client has a duty to report – Attorney for client is looking for medical expenses paid as related to the injury – Medical Service Questionnaires are generated – Refer calls/correspondence to BRS Tort Liability Types of Tort TPL – Workers’ Compensation (DOLI data match) – Auto no-fault/auto litigated – Homeowners’ Insurance – Medical Malpractice – Product liability (rx drugs, devices, etc.) – Personal Liability – Class Action or Multiple Plaintiff Cases MSQ Process ―Standard Work‖ (final) FAQs Document (See Handout—Att. D) MMIS Changes Improve compliance with form completion/return Reduce turn-around time Form Revision Simplify form & use ―flash print‖ or ―script‖ process rather than hard copy forms (pinfeed) DHS 2237/2237A See Handout—Att. C Proposed New MSQ Process Daily process and direct mail of First/Sec. Notice MSQs Move parameters on notices up (from 90 days to 60 days to 45 days) Rely on county staff to apply closing guidelines at Worker Message MA Lien & Estate Recovery County agency staff send MA Lien Referral Worksheets and SNT Referrals to BRS BRS staff file MA property liens when appropriate and monitor SNT clients County Agency staff file estate claims upon the death of the last surviving spouse BRS provides technical assistance to county collections staff Medicare Revenue Enhancement (MREP) Program to ensure that Medicare benefits are used first for LTC Services LTC facilities required to submit documentation for review of potential cases Technical assistance provided to LTC facilities re: Medicare, and other requirements Deficit Reduction Act (DRA) & LTC Partnerships MN passed implementing language effective 07/01/06 based on DRA authority given to states – More people will be buying LTC insurance which may or may not be Partnership qualified – All LTC insurance has the effect of protecting assets (by virtue of providing the benefit) Goals Effective communication with external customers (develop and maintain presence on public and county websites, etc.) More efficient processes with better results Continue to review & implement changes Questions? 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