Verisk Analytics, Inc. · NASDAQ:VRSK

Verisk Analytics — Corporate Update (February 2025)

55 slides from Verisk Analytics's corporate update, February 2025

Slide 1: Medicare Watch List – 2025
Today’s Presenters Medicare Watch List – 2025 Mark Popolizio, J.D. Sidney Wong, J.D. VP, MSP Compliance VP, Policy [email protected] [email protected] 786.459.9117 978.825.8262 ©Verisk Analytics, Inc. All rights reserved. 1
Slide 3: Today's Focus Points
Today’s Focus Points • Medicare/CMS 2025 – being prepared and staying compliant • Core MSP obligations and key CMS updates • Revisiting and re-tooling your MSP best practices • Look for the “blue” summary slides! • How Verisk services can help you achieve “end-to-end” MSP compliance! • Questions/Ans
Slide 4: Medicare Secondary Payer – The Big Picture
Medicare Secondary Payer – The Big Picture Section 111 Reporting Conditional Payment Future Medical Treatment Recovery • Mandatory electronic (MSA) reporting • Payments by Medicare when there is another responsible • Mitigates shifting the medical • Applicable to Liability, WC & entity burden to Med
Slide 5: Single Source = Automation and Mitigated Risk
Single Source = Automation and Mitigated Risk Holistic Data Driven Medicare Compliance Verisk Error-free CMS Reporting Medicare Liens MSP Navigator CP Link Missing Data Smart Search PAID Link Add-On Automated data feed WCMSA Data Auto Population from S.111 power your Verisk intakes claims S.111 MSP
Slide 6: Medicare Watch List 2025 – MSP Items & Application
Medicare Watch List 2025 – MSP Items & Application MSA Medicare Recovery (Includes TPOC/WCMSA, Section 111 CMPs Claims $0 WCMSA, Amended Review) Workers’ Compensation ✓ ✓ ✓ Liability ✓ ✓ - No-Fault, Med-Pay, etc. ✓ ✓ - ©Verisk Analytics, Inc. All rights reserved. 6
Slide 8: When can CMS impose Civil Money Penalties (CMPs)?
When can CMS impose Civil Money Penalties (CMPs)? Section 111 Civil Money Penalties (CMPs) – Final Rule When can you be penalized? How will CMS Evaluate? • Under the final rule, the single basis for potential CMPs is untimely TPOC and • For TPOC ➔ CMS will assess timeliness ORM reporting. based on t
Slide 9: CMPs Penalty Calculation
CMPs Penalty Calculation CMS will use a “tiered” approach to penalize RREs as follows: “The longer you are late, the more you will pay!” Tier 1 $368.50 for each calendar day Over 1 year late, (Current adjusted inflation rate – but less than two years Fed. Reg. August 2024) Tier 2 $737 for each calen
Slide 10: CMPs Key Dates & Scope
CMPs Key Dates & Scope January 1, 2026 December 11, 2023 October 11, 2024 October 11, 2025 Randomized Rule became Rule becomes Earliest CMPs may quarterly audits effective applicable be imposed begin Per CMS’s January 2024 webinar and CMPs webpage: ✓ Only coverage record submissions with coverage ef
Slide 11: CMS's Section 111 "good faith" safe harbor
CMS’s Section 111 “good faith” safe harbor – Question: Answer: Will RREs be protected from CMPs if Yes… ** IF ** the RRE follows CMS’s they cannot get the “Big Five” data Section 111 “good faith” compliance points from the claimant (or his/her safe harbor criteria lawyer or other rep)? (Next slide)
Slide 12: CMS's "Good Faith" Compliance Safe Harbor Criteria
CMS's "Good Faith" Compliance Safe Harbor Criteria RRE has communicated the need for the RRE has not received a response OR has 1. Big 5 data points to the individual and his or 3. received a written response from the her attorney, or other representative, if individual or their attorney or represen
Slide 13: Section 111 CMPs – Notice & Appeal
Section 111 CMPs – Notice & Appeal 1. Informal Notice and 2. Formal Notice 3. Appeal Mitigating Evidence • CMS will first give “informal” notice • CMS will issue a “notice of • Must appeal within 60 calendar • RREs can then submit “mitigating proposed defemination” if: days of receipt of notice of e
Slide 14: Imposing CMPs – Final Determination
Imposing CMPs – Final Determination Notice of Final Determination CMS is looking for CMPs payment! Notice of Final Determination will Key Points be issued if the RRE: a) does not request a hearing or appeal, • Confirms that the RRE’s CMP is final. b) elects to terminate the appeals process, or • Not
Slide 15: Going Forward in 2025 – Section 111 CMPs Summary
Going Forward in 2025 – Section 111 CMPs Summary What to Know… Improving MSP Best Practices ✓ Section 111 penalties are live 1. Understand CMS’s CMPs provisions ✓ CMS will start to levy penalties in October 2. Review current practices to obtain Big 5 data against CMS’s “good faith” ✓ RREs can be pen
Slide 16: S.111 Reporting Solution – MSP Navigator
S.111 Reporting Solution – MSP Navigator Customizable solutions that ensure S.111 reporting accuracy • Error-Free Reporting with proactive data validation Data and Metrics • Claim system integrations and multiple file • For Section 111 claims reported to CMS exchange options – Implementation acceler
Slide 17: Data Flow
Data Flow Return files created and/or reports accessible via web 2 portal and MSP Analyzer ✓ User Alerts (real time with API exchange) Return files integrated ✓ Eligibility Results (monthly) 3 as proactive alerts ✓ Missing S.111 Data (real time with API exchange) Query files (monthly) and within Cla
Slide 18: Self Service Management Reports – MSP Navigator Web Portal
Self Service Management Reports – MSP Navigator Web Portal Missing Query Missing S.111 Reportable Claims for CMS Reporting Eligibility Data Data Data Claims Withheld Review Summary Mismatch • Claims missing • Reportable claims • Claims with missing • Open claims for • Breakout of • Highlights Applie
Slide 19: Missing Data Smart Search
Missing Data Smart Search Obtain missing SSN & DOB data points to ensure compliance MSP Navigator Client Generates file of Exchanges files updates claims claims missing Drops results with third party with new info and SSN and DOB with in client’s to obtain resubmits data claimant address SFTP folder
Slide 20: MSP Analyzer
MSP Analyzer Self-service data analytics providing holistic visibility into Medicare Compliance results Insight into all Verisk-reported and data Access configurable at the TPA and RRE level aggregated claims for Verisk-reported and aggregated claims CMP dashboard ensures claims are reported SSO via
Slide 22: TPOC/WCMSA Reporting – At a Glance
TPOC/WCMSA Reporting – At a Glance • WC settlements involving Medicare beneficiaries Applicability • Apply to coverage reports with TPOC dates April 4, 2025, or later • WCMSAs submitted to CMS for review/approval WCMSAs and any • Non-Submit and EBMSAs other Future • WCMSAs in lower dollar settlement
Slide 23: TPOC/WCMSA – Practical Claims View
TPOC/WCMSA – Practical Claims View WC settlement with a Medicare beneficiary Settlement Greater than $25K Settlement $25K or Less No WCMSA or “Threshold Settlement” “Non-Threshold Settlement” $0 Dollar WCMSA • Settlement meets CMS’ • Settlement does NOT meet • “$0” MSA value must be voluntary WCMSA
Slide 24: How will CMS use this information?
How will CMS use this information? As part of its November 2023 webinar, CMS stated: Common Working File Claimant Notification Collected data to supplement A WCMSA record will be Notification of the WCMSA will existing WCMSA process posted to the Common be sent to the beneficiary CMS will continue t
Slide 25: Going Forward in 2025 – TPOC/WCMSA Reporting Summary
Going Forward in 2025 – TPOC/WCMSA Reporting Summary What to Know… Improving MSP Best Practices 1. Understand CMS’s TPOC/WCMSA ✓ TPOC/WCMSA reporting starts reputing requirements 4/4/2025 2. Update your claims/S.111 platforms to ✓ RREs are required to submit WCMSA capture WCMSA reporting data data p
Slide 26: TPOC/WCMSA – Verisk Services Snap-shot
TPOC/WCMSA – Verisk Services “Snap-shot” MSA Link • Leverages existing S.111 data to Benefits identify when a claim is ready for an • Ensures every claim gets the right MSA allocation at the right time for that claim per your protocols • Automates initiation of the appropriate service per your proto
Slide 27: Data-Driven MSA
Data-Driven MSA Data-Driven MSA Benefits • Designed for “low dollar” settlements (WC settlements w/Medicare • Ensures consistent process and beneficiary for $25k or less) protocol adherence • Fast turnaround time • Automated/data-driven MSA calculation • Cost effective • Helps facilitate compliance
Slide 28: Simplifying TPOC/WCMSA reporting – Discovery Nav TPOC MSA Module
Simplifying TPOC/WCMSA reporting – Discovery Nav TPOC MSA Module: Settlement Doc Scan • Determine best approach(es) to capturing MSA data within claims system ✓ Manual, potential error-prone burden for claims staff? Or… ✓ Automate with Verisk’s Discovery Navigator TPOC WC MSA Module to retrieve data
Slide 31: $0 WCMSA Requests – New Change Effective 7/17/2025
$0 WCMSA Requests – New Change Effective 7/17/2025 Effective 7/17/2025, CMS will no longer accept or review $0 WCMSA requests – but states that parties “should maintain documentation to support that allocation.” (WCMSA Reference Guide, Section 4.2) Under Section 4.2, CMS notes the following bases fo
Slide 32: Going Forward in 2025 – $0 WCMSA Changes Summary
Going Forward in 2025 – $0 WCMSA Changes Summary What to Know… Improving MSP Best Practices 1. Submit ripe $0 WCMSA requests before ✓ Effective 7/17/2025, CMS will no 7/17/25 longer review $0 WCMSA submissions 2. $0 WCMSAs are still applicable and will be post 7/17/25! ✓ CMS directs parties to WCMSA
Slide 34: Challenging CMS WCMSA Approvals
Challenging CMS WCMSA Approvals Re-Review Amended Review a/k/a a/k/a “rebuttal” “Second Look” Mathematical Error Parties can submit new medical documentation to New information that pre-dates CMS to adjust a prior WCMSA original submission approval in certain cases! Let’s take a look! Submission Err
Slide 35: Challenging CMS – Amended Review
Challenging CMS – Amended Review Criteria What to look for (common triggers) 1. Allowed one time; • Surgeries or implants have occurred 2. CMS has issued a conditional approval/approved amount at least 12 months prior; Note: Effective 4/7/25, CMS is eliminating this • Change in medication regimen on
Slide 36: Going Forward in 2025 – Amended Review Summary
Going Forward in 2025 – Amended Review Summary What to Know… Improving MSP Best Practices 1. Understand CMS’s new change ✓ Effective 4/7/2025, CMS will eliminate the one-year time period to submit an 2. Review your current Amended Review Amended Review request practices ✓ This will allow parties to
Slide 37: MSA Second Look (CMS's "Amended Review" Process)
MSA Second Look (CMS’s “Amended Review” Process) Second Look / Key Features Second Look – Benefits • Analysis of whether claim will qualify for “Amended Review” ✓ Helps you optimize CMS’s Amended Review Process • Identification of cost mitigation options and strategies ✓ Opportunity to reduce prior
Slide 38: Verisk's Provider Outreach
Verisk’s Provider Outreach Provider Outreach / Key Features Benefits • Record Acquisition active engagement with providers to obtain missing records Expertise in Medicare & CMS review • Nurses & Attorneys Identify cost drivers and cost practices to identify the documentation mitigation opportunities
Slide 39: How Verisk can Help! – MSA and Allocation Services
How Verisk can Help! – MSA and Allocation Services Proactive and customizable services to help you reduce costs and settle claims… • Medicare Set Aside Benefits of our Approach: • Evidence Based MSA or Indemnified Evidence Based MSA • Medical/ Legal Dedicated Team • Data-Driven MSA • Proactive Cost
Slide 41: Medicare Recovery Claims 2025 – Nutshell
Medicare Recovery Claims 2025 – Nutshell 1. Medicare Recovery Claims – General 2. CMS Conditional Payments • CMS conditional payments (Parts A/B) • Section 111 Query helps determine Medicare status ✓ Including Treasury Claims • CMS uses Section 111 reporting to drive recovery • Medicare Advantage (P
Slide 42: Medicare Parts A and B – CMS Conditional Payment Recovery
Medicare Parts A and B – CMS Conditional Payment Recovery CMS – Highlights • CMS (federal gov’t) has strong rights ✓ Can pursue insurer, claimant, and/or claimant attorney ✓ Interest accrual Parts A and B (Traditional Medicare) ✓ Treasury claims (including offset) ✓ Double Damages Conditional paymen
Slide 43: Parts A & B: Which Contractor Does CMS Use and When?
Parts A & B: Which Contractor Does CMS Use and When? CRC Recovery • CRC pursues WC/NF Claims when ORM = YES ORM • Debtor = Carrier/Self-Insured CMS uses CRC On-going • Authorization Required = Letter of Authority (LOA) responsibility • CRC Correspondence is time sensitive for medicals • Deadlines mu
Slide 44: Medicare Advantage (Part C) Recovery Claims
Medicare Advantage (Part C) Recovery Claims Medicare Advantage Plans (MAPs) – Highlights • Medicare plans provided by private insurers (not CMS) • 33 million people are enrolled in a MAP – 54% of all Part C Medicare beneficiaries – close to 4,000 plans nationally (Medicare Advantage) • Top three MAP
Slide 45: Medicare Advantage Plans: "Double Damages" Issue
Medicare Advantage Plans: “Double Damages” Issue U.S. Circuit Court of Appeals (2nd Cir.)(CT, NY, VT) Can Medicare Advantage Plans sue for double damages? U.S. Circuit Courts of U.S. Circuit Appeals = Yes Court of Appeals (3rd Cir.) U.S. District Court(s) = Yes (DE, NJ, PA, U.S.-VI) Not yet addresse
Slide 46: Medicare Part D (RX Drugs) Recovery Claims – Nutshell
Medicare Part D (RX Drugs) Recovery Claims – Nutshell Part D – Highlights • Outpatient prescription drug plans provided by private insurers • Stand alone prescription drug plans PDPs (Parts/AB) Part D • Medicare Advantage prescription drug plans MA-PDs (Rx Drugs) • 49 million Medicare beneficiaries
Slide 47: How Verisk can Help! – Conditional Payments/Lien Services
How Verisk can Help! – Conditional Payments/Lien Services Proven services to address and reduce conditional payments and other lien claims • CMS Conditional Payment claims (Medicare Part A/B) – Identification/negotiation Advocacy driven services to reduce costs: • Medicare Advantage (Part C) and Par
Slide 48: CP Link – Automating Medicare Recovery ("lien") Claims
CP Link – Automating Medicare Recovery (“lien”) Claims CP Link is our programmatic solution Benefits of our Approach: address Medicare conditional payments: • Ensures complete Compliance • Integrates Section 111 reporting and • Provides insight/visibility (risk, efficacy, Medicare conditional paymen
Slide 50: Other Watch List Items
Other Watch List Items LMSA RAMP Act MSP case law Will the RAMP Act Will we see new Medicare Will CMS revisit MSAs? be re-introduced into Advantage “double Congress? Other possible damages” decisions? MSP reform bills? Other MSP decisions? ©Verisk Analytics, Inc. All rights reserved. 50
Slide 52: Medicare 2025 Watch List Report – Coming Soon!
Medicare 2025 Watch List Report – Coming Soon! Our annual (and popular) “Prospective look” at MSP compliance comprehensive MSP report! topics for 2025 Breaking down core requirements Practical claims strategies to stay and new policies compliant and reduce costs Helpful roadmap to re-tool your How V
Slide 54: Questions?
Questions? Mark Popolizio, J.D. Sidney Wong, J.D. VP, MSP Compliance VP, Policy [email protected] [email protected] 786.459.9117 978.825.8262 ©Verisk Analytics, Inc. All rights reserved. 54
Slide 55: Thank You!
Thank You! Standard legal language is pending. Until the template is updated with standard boilerplate, please insert the appropriate legal language for your business area. ©Verisk Analytics, Inc. All rights reserved. 55

Verisk Analytics — Corporate Update (February 2025) on 6ix

Verisk Analytics — Corporate Update (February 2025)

Slide 1: Medicare Watch List – 2025

Slide 2: Medicare Watch List 2025

Slide 3: Today's Focus Points

Slide 4: Medicare Secondary Payer – The Big Picture

Slide 5: Single Source = Automation and Mitigated Risk

Slide 6: Medicare Watch List 2025 – MSP Items & Application

Slide 7: Item #1 Section 111 Penalties

Slide 8: When can CMS impose Civil Money Penalties (CMPs)?

Slide 9: CMPs Penalty Calculation

Slide 10: CMPs Key Dates & Scope

Slide 11: CMS's Section 111 "good faith" safe harbor

Slide 12: CMS's "Good Faith" Compliance Safe Harbor Criteria

Slide 13: Section 111 CMPs – Notice & Appeal

Slide 14: Imposing CMPs – Final Determination

Slide 15: Going Forward in 2025 – Section 111 CMPs Summary

Slide 16: S.111 Reporting Solution – MSP Navigator

Slide 17: Data Flow

Slide 18: Self Service Management Reports – MSP Navigator Web Portal

Slide 19: Missing Data Smart Search

Slide 20: MSP Analyzer

Slide 21: Item #2 TPOC/WCMSA Reporting (Starts 4/4/2025)

Slide 22: TPOC/WCMSA Reporting – At a Glance

Slide 23: TPOC/WCMSA – Practical Claims View

Slide 24: How will CMS use this information?

Slide 25: Going Forward in 2025 – TPOC/WCMSA Reporting Summary

Slide 26: TPOC/WCMSA – Verisk Services Snap-shot

Slide 27: Data-Driven MSA

Slide 28: Simplifying TPOC/WCMSA reporting – Discovery Nav TPOC MSA Module

Slide 29: Discovery Nav TPOC MSA Module: Settlement Doc Scan

Slide 30: Item #3 $0 WCMSA Changes (Starts 7/17/2025)

Slide 31: $0 WCMSA Requests – New Change Effective 7/17/2025

Slide 32: Going Forward in 2025 – $0 WCMSA Changes Summary

Slide 33: Item #4 Amended Review Changes (Starts 4/17/2025)

Slide 34: Challenging CMS WCMSA Approvals

Slide 35: Challenging CMS – Amended Review

Slide 36: Going Forward in 2025 – Amended Review Summary

Slide 37: MSA Second Look (CMS's "Amended Review" Process)

Slide 38: Verisk's Provider Outreach

Slide 39: How Verisk can Help! – MSA and Allocation Services

Slide 40: Item #5 Medicare Recovery Claims

Slide 41: Medicare Recovery Claims 2025 – Nutshell

Slide 42: Medicare Parts A and B – CMS Conditional Payment Recovery

Slide 43: Parts A & B: Which Contractor Does CMS Use and When?

Slide 44: Medicare Advantage (Part C) Recovery Claims

Slide 45: Medicare Advantage Plans: "Double Damages" Issue

Slide 46: Medicare Part D (RX Drugs) Recovery Claims – Nutshell

Slide 47: How Verisk can Help! – Conditional Payments/Lien Services

Slide 48: CP Link – Automating Medicare Recovery ("lien") Claims

Slide 49: Item #7 Other Watch List Items

Slide 50: Other Watch List Items

Slide 51: Verisk Resources

Slide 52: Medicare 2025 Watch List Report – Coming Soon!

Slide 53: Verisk Resources

Slide 54: Questions?

Slide 55: Thank You!