Settling a claim with a future medical component often comes with an obligation to ensure that Medicare’s interests are considered. While there are a variety of strategies that may be considered, the creation of a Medicare Set-Aside (MSA) Allocation Report is an industry standard approach to not only identifying the total possible future medical exposure under the Medicare Secondary Payer Act, but to also limiting how much of a total settlement is expected to pay as primary to Medicare after settlement.
American Settlement Corporation has partnered with Medivest to offer MSA Allocation Reports to workers’ compensation and general liability settlements. We understand the myriad factors that must be taken into consideration when preparing for settlement.
Having participated in the settlement process of thousands of claims, we know that a MSA report that doesn’t consider the factors unique to each settlement can create an unnecessary hassle for the parties. We work with Medivest on each MSA Allocation Report that we provide to maximize to the greatest extent possible favorable outcomes that satisfy obligations under the Medicare Secondary Payer Act (MSP) and the needs of the settlement stakeholders.
Managing the CMS Approval Process
Today’s CMS workers’ compensation review contractor (WCRC) is continuously updating standards for MSA review and approval. This is resulting in unexpected “counter-highers” on approvals by the WCRC. American Settlement Corporation works closely with Medivest to identify potential problems in the current treatment plan of claimants and actively recommends strategies to mitigate problematic inclusions where possible. We equip settling parties to make informed settlement decisions that factor WCRC expectations, treatment change options, and the limitations settlement conditions place on goals and expectations of the settling parties.
Evidence Based Projection Options
As CMS has stated, the submission and approval process for MSAs is entirely voluntary. More and more, people are applying a “no-submit” approach to their MSP compliance strategy. In some of these cases, guidelines that emphasize medical compendia-based calculations and actual treatment regimens are being applied to the MSA projection process, rather than CMS’ published guidance. American Settlement Corporation can provide MSA Allocation Reports that embrace this approach while producing a future total that adequately considers Medicare’s interests under the MSP.
Lien Investigation and Entitlement Verification
Included with each MSA Allocation Report prepared, American Settlement Corporation will perform a conditional payment lien investigation with the Benefits Coordination & Recovery Center (BCRC) to determine any past payments made by Medicare for the injury that CMS may recover. We will review all conditional payment to identify and appeal any payments which CMS may incorrectly identify as related to the injury in order to reduce the final demand. We will also undertake the necessary Medicare entitlement steps to determine whether a MSA Allocation Report is appropriate for a given claim.
We believe we bring to the table a unique experience for our customers in that we actively participate in the MSA Allocation Report process on behalf of our customers by leveraging our understanding on the individual claim’s particular details. Please contact us today to discuss how American Settlement Corporation can help you effectively manage your MSP exposure.