Sharpline Allocations

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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 Consultant and Registered Nurse address all legal and medical aspects of the MSA.  We identify and implement cost saving solutions in order 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 Consultant and Registered Nurse address all legal and medical aspects of the MSA.  We identify and implement cost saving solutions in order 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 Consultant and Registered Nurse and allows you to have full confidence that Medicare’s interests have been considered.

Zero MSA opinion letter (abbreviated evaluation at a reduced fee)

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 Consultant 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 indentifying 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. 

Professional Administration of Medicare Set Aside

We identify when a professionally administered MSA is necessary, set up the MSA custodial account, and manage the MSA throughout the remainder of the claimant’s lifetime.  We will ensure that the funds are properly maintained, that providers are promptly and accurately paid and that all administrative reports are filed with Medicare when required.    

CMS- Centers for Medicare and Medicaid Services

Submittals to CMS

We determine whether your settlement meets the CMS review thresholds then submit the MSA to CMS for approval. Obtaining CMS approval is a technical process through which we provide expert guidance to avoid pitfalls. We handle all necessary submittal and documentation requirements and manage the process through completion.   In the event that CMS disagrees with our MSA proposal, we will aggressively advocate for a re-review free of additional charge.

Medicare conditional payment research and resolution

When you anticipate settlement of a 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, determine if it will be seeking a lien against your settlement, and if necessary, dispute the amount of the conditional payments.  We obtain “No-Lien” documentation 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 in order 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.  There is no charge for status checks if conducted in connection with an MSA allocation.

Cost Containment

Medical Cost Projection

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

Rx Review

Our Rx Review is specifically designed to help both the Carrier and the Claimant contain the costs of prescription medication.  Our Rx Review helps to reduce medication usage and cost through pharmacist-supported review of a claimant’s prescription drug regimen. The Rx Review will evaluate the appropriateness and long-term cost-effectiveness of the present medications and then suggest an acceptable, less-expensive alternative regimen. In most cases, this results in substantial cost savings.  Our Rx Review can be accomplished pre-settlement to manage the prescription costs throughout the duration of the claim or closer to settlement to further reduce the cost of the MSA and the Claimant’s post-settlement costs.

File review

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

MSP Compliance Program and Education

We offer assistance with developing and implementing an MSP Compliance Program 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.