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Services

Medicare Set Aside Services

Workers’ Compensation/Longshore/Defense Base Act Medicare Set Asides

For your Workers’ Compensation, Longshore and Harbor Workers’ Compensation or Defense Base Act claims, we provide the lowest defensible MSA appropriate for your claim.  Our highly experienced Medicare Set Aside Certified Consultants and Registered Nurse address all legal and medical aspects of the MSA.  We identify and implement cost saving solutions to reduce the MSA.  We utilize established nationwide partnerships with structured settlement brokers to obtain rated ages, as well as structured annuities to settle claims with reasonably priced MSAs.  Updated MSAs are free of charge if completed within 6 months of the initial MSA.

Liability Medicare Set Aside

In connection with a liability, personal injury, or no-fault case, we recommend the best solutions for full MSP compliance and provide the lowest defensible MSA appropriate for your claim.  Our highly experienced Medicare Set Aside Certified Consultants and Registered Nurse address all legal and medical aspects of the MSA.  We identify and implement cost saving solutions to reduce the MSA.  We utilize established nationwide partnerships with structured settlement brokers to obtain rated ages, as well as structured annuities to settle claims with reasonably priced MSAs.  Updated MSAs are free of charge if completed within 6 months of the initial MSA.

Zero Medicare Set Aside (full evaluation)

We provide you with a zero MSA allocation confirming that no future medical care is anticipated.  Our zero MSA allocation allows you to properly document your file and ensures full MSP compliance. The zero MSA recommendation is based upon the determination made by our highly experienced Medicare Set Aside Certified Consultants and Registered Nurse, that allows you to have full confidence that Medicare’s interests have been considered.

Zero MSA Opinion Letter

We provide you with a zero MSA opinion letter confirming that no future medical care is anticipated when a claim has been denied and no payments have ever been made by the Carrier/Employer. Our zero MSA opinion letter allows you to properly document your file and ensures full MSP compliance. Our zero MSA opinion letter is based upon the determination made by our highly experienced Medicare Set Aside Certified Consultants and allows you to have full confidence that you have considered Medicare’s interests.

Second Opinions in Workers’ Compensation or Liability Claims

If you are not satisfied with your current MSA, we will review the MSA and provide you with alternative recommendations with an eye toward identifying aggressive cost-containment options. We then provide an updated, reduced MSA, so that you will be in the best position to settle the open claim when it may have been previously unfeasible to do so. 

CMS- Centers for Medicare and Medicaid Services

Medicare Set Aside Submittals to CMS

After carefully partnering with you, we work to determine whether your settlement meets the CMS workload thresholds. We then meticulously review the MSA proposal packet and submit the MSA proposal to CMS for approval. Our expert team is well versed in the submittal process and provide expert guidance to avoid pitfalls and unnecessary delays.

Medicare Set Aside Re-Review

Sometimes Medicare provides an approval letter for a Medicare Set Aside which contains an error, either mathematical or during the initial review. When this occurs, we submit an aggressive re-review and advocate for removal of any mistakenly included treatment or prescription medication from the approval letter free of charge.

Medicare Set Aside Amended Review

Sometimes a Medicare Set Aside approval letter is issued, but settlement of the claim is stalled. If the treatment or prescription medication has changed wherein the original MSA approval letter cost will change by 10% or $10,000.00, whichever is greater, and the approval letter is older than 1 year and younger than 4 years old, the MSA is eligible for Amended Review. We partner with you to review the new medical records, develop an aggressive strategy to reduce the MSA and submit the amended review to Medicare.

Medicare Lien Research and Resolution

We partner with you to determine whether there is a Medicare Lien for your Workers’ Compensation, Longshore and Harbor Workers’ Compensation, Defense Base Act or Liability claim for a Medicare beneficiary. We confirm whether Medicare made any conditional payments, related to the claim and if necessary, dispute all unrelated charges. We obtain Dispute Approval Letters, Final Demand Letters, and Case Closure Letters when appropriate so that you may properly document your file and finalize the settlement.

Social Security Disability & Medicare Status Checks

We provide an expedited verbal Medicare status check to determine whether a claim requires an MSA, submission to CMS, and/or conditional payment verification. The initial status check is then followed up with written confirmation of Medicare and Social Security Disability status so that you may properly document your file.

Cost Containment

Medical Cost Projection

Our highly experienced Medicare Set Aside Certified Consultants and Registered Nurse provide you with an MCP to assist you in setting reserves and determining your settlement parameters. Following careful review of the medical records, prescription ledger payment history, we accurately calculate the likelihood and extent of future medical care and anticipated expenses. Further, we identify and implement cost saving solutions to reduce the MCP. Updated MCPs are free of charge if completed within 6 months of the initial MCP, and can easily be converted into MSA’s upon request.

Pre-MSA Exposure

The Pre-MSA provides a future medical road map to our clients so they can see what the costs would be and provides recommendations for mitigating the future MSA costs. This is recommended for any catastrophic case, or cases where the current medical treatment costs make settlement prohibitive.

Drug Utilization Review

Drug Utilization Review is specifically designed to help both Carrier and Claimant manage the costs of current and future prescription medication. Through a pharmacist-supported review of the prescription drug regimen, an evaluation of the appropriateness of medications, and review of the long-term cost-effectiveness of the present medications. DUR can provide an acceptable, less-expensive alternative regimen which can result in substantial cost savings. We will partner with your preferred provider to obtain a DUR on your behalf. Drug Utilization Review is most effective when completed pre-settlement to manage the prescription costs throughout the duration of the claim, but is also an effective tool closer to settlement to further reduce the MSA and post-settlement costs.

File Review

We review your open claims to determine which files would benefit from an MSA, MCP, or Drug Utilization Review and provide workable solutions to lower your expenses during the life of the claim as well as reduce the MSA exposure upon settlement.

Rated Age/ Annuity Quotes

We review the medical records to identify diagnoses which affect the life expectancy of Claimant. We then partner with your preferred structured settlement broker or our designated underwriter to obtain a rated age, which reduces the life expectancy and potentially reduces the total cost of the future medical and prescription care. We also work with your preferred structured broker to obtain annuity quotes for the MSA’s and MCP’s to provide further cost savings.

MSP Compliance Program and Education

We partner with you to develop and implement an MSP Compliance Program specifically tailored for your company. Our Medicare Set Aside Certified Consultants and training staff will educate your adjusters and risk managers on how to recognize MSP issues, identify when an MSA and submittal to CMS is necessary, how to reduce costs, and when a settlement may proceed without an MSA or submittal.