Answers to Frequently Asked Questions
Susan U. Sheerin
RN, CLCP, MSCC, CGCM
Why do I need a board certified life care planner (CLCP)?
The CLCP is the only certification that provides specific ethical guidelines for life care planners. Planners who do not carry the CLCP certification are not subject to review or discipline by the certification board. The certified life care planning credential is one of the few healthcare related certifications that did not allow grandfathering. All individuals with the CLCP certification are required to successfully complete an approved life care planning program, provide a life care plan for peer review and pass the written board examination.
Who is the CHCC?
The CHCC is the Commission on Health Care Certification, a governing body which evolved from the Commission on Disability Examiner Certification in 1996. It is the premier certifying agency in life care planning service and reviews the process of providing credentials. Qualifications necessary to sit for the CLCP examination are extremely restricted.
What is the Medicare Secondary Payer Statute (MSP)?
The MSP is federal legislation designed to prevent shifting of responsibility for medical treatment from a primary payer to insurance carrier to Medicare.
Does Medicare enforce the Medicare Set-Aside (MSA)?
They do now! The Centers for Medicare/Medicaid Services (CMS) may pursue a private cause of action seeking double damages for failure to provide reimbursement to Medicare for conditional payments.
When was the MSP created?
The MSP was created by the Omnibus Reconciliation Act of 1980 and over the years has undergone a series of amendments, but until recently was not enforced. The result of a study by the Government Accounting Office (GAO) conducted between 1991 and 1998, found that Medicare spent nearly 40 billion dollars in workers' compensation medical care that were, in actuality, the responsibility of the workers' compensation carrier. This resulted in Medicare issuing its first memorandum, dated July 23, 2001, serving notice that the MSP would be enforced, and describing the type of claims that would be impacted, and the penalties for failure to comply. Subsequent memos have followed, creating the need for all involved to stay abreast of continuing changes in Medicare policies.
Can the parties proceed with settlement of the medical expenses portion of a WC claim before CMS actually reviews the proposal and determines if Medicare's interest is adequately protected?
Yes, however if the CMS does not subsequently provide approval of the funded amount as specified in the settlement and proof is not provided to CMS that the amount has been fully funded, CMS may deny payment for services related to the WC claim up to the full amount of the settlement.
Is an MSA only for those on workers' compensation?
No. It may include liability claims, medical malpractice, product liability, auto insurance / no fault and nursing home abuse cases.
What can a legal nurse consultant do for me?
A nurse consultant can speed up the process of medical record interpretation, getting to the heart of the case and providing the right questions to be asked of the expert witness. The consultant can answer your medical questions, assisting in research that will help you avoid unproductive and costly wading through technical medical articles. Consultations can range from simple phone assistance to the compilation of detailed chronologies encompassing many years of the client's history. Every consultation is tailored to your exact needs.