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A “Tiered Approach” to Medicare Secondary Payer Compliance (MSAs) for “Futures” Exclusively for Liability Settlements

Synergy has developed a tiered approach to MSP compliance as it relates to “futures” exclusively for 3rd party liability settlements.  It is as follows:

MSA Consultation & Waiver Preparation:  $500

MSA “Estimate”:  $1,000

MSA “Estimate” & Reduction Opinion Letter (for cases where there is a limited recovery):  $1,500

Full MSA Allocation (meeting CMS guidelines from WCMSA memos):  $3,000

The first option (consultation & waiver) would be for cases where the client needs to have the issues explained to them and to identify their options.  If they decline, we create a customized waiver for them to sign.  That is the $500 cost.  The second option (estimate) would be for cases that are “small” or where future medical is quite “small” and instead of a full allocation being created to comply with CMS guidelines, an estimate is done.  We prepare the estimate based on a medical summary you provide to us instead of a full review of all of the medical records.  The third option combines the second option with a reduction opinion letter for cases where the recovery is small relative to the total damages.  For example, you recover policy limits of $200k but the value of the case is $2,000,000.  In that situation, we would estimate future medicals that are Medicare covered then reduce that amount down based upon the limited recovery by using an Ahlborn formula.   The final option is a full Medicare Set Aside allocation which is prepared based upon CMS guidelines and after review of all medical records from the date of the accident forward or the last three years.  This method fully protects the client and is as complete Medicare Secondary Payer compliance as you can get.  Synergy decided to offer these services given the realities of many settlements in the liability context.  They provide multiple resolution options for you to protect yourself and the client as much as possible from MSP related compliance issues.

In addition, Synergy offers a Medicare Set Aside Administration program through the use of a trust agreement administered by a corporate trustee and a separate professional Medicare Set Aside administrator. With a Medicare Set Aside Trust, the injury victim has a professional trustee that has a fiduciary duty paired with a set aside Administrator, who handles the medical bill auditing and reporting to CMS. If the trustee or administrator can no longer perform their duties, a new trustee or administrator may be appointed but the fiduciary obligations and creditor protections of the trust remain. Trusts are covered by state trust and fiduciary laws. Synergy’s Medicare Set Aside Administration program is different because it employs a Medicare Set Aside Trust arrangement instead of a custodial agreement like most other professional administration programs. This arrangement provides another layer of protection for the MSA funds.

To learn more about how Synergy can help with MSP compliance, visit www.synergymsa.com and www.synergylienres.com

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