Ohio Workers' Comp Settlements & Medicare » Horenstein ...
The Problem
When an injured worker settles his or her workers’ compensation claim the interests of Medicare must be protected with regard to conditional payments of medical bills made by Medicare to medical providers for treatment of the allowed conditions prior to the settlement. Medicare’s interests must also be protected with regard to future payments to medical providers for treatment of the allowed conditions. Stated differently, if Medicare has paid or pays in the future medical bills for treatment of the allowed conditions, Medicare wants its money back. The problem is how to best accomplish this in the context of complex and ever changing rules from the Centers for Medicare & Medicaid Services (CMS), which is the federal agency responsible for enforcing the Medicare Secondary Payer Act, 42 U.S.C. § 1395y(b)(2).
In the context of Ohio workers’ compensation claims, the Medicare Secondary Payer Act prohibits Medicare from paying for an injured worker’s medical services for treatment of the allowed conditions in claims where payment has been made or can reasonably be expected to be made by the Ohio Bureau of Workers’ Compensation (BWC) or by an Ohio self-insured employer. In such cases Medicare is considered the “secondary payer” and the BWC (or self-insured employer) the “primary” payer. There is an exception to this prohibition. The Medicare Secondary Payer Act permits “conditional” payments for medical treatment of conditions covered by or likely to be covered by a workers’ compensation claim in situations where the payment for medical services under the workers’ compensation claim cannot be expected to be made promptly. When conditional payments have been made by Medicare, the BWC or self-insured employer must reimburse Medicare when the workers’ compensation claim is allowed. At that point the BWC or self-insured employer becomes the primary payer with respect to past and future medical bills for treatment of the allowed conditions.
Headlines to take note of: Ohio Bureau of Workers’ Compensation proposes reduced costs
Headlines to take note of: Ohio Bureau of Workers’ Compensation proposes reduced costs
Headlines to take note of: Ohio Bureau of Workers’ Compensation proposes deep premium discounts
Important to Worker's Comp: Ohio Bureau of Workers’ Compensation to provide reduced costs
Headlines to take note of: Ohio Bureau of Workers’ Compensation proposes deep premium discounts Ohio Workers Compensation - Bookshelf
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