Category Archives: MSAs

Liability Medicare Set-Asides (LMSAs): Is It Time to Start Worrying?

B. Josh Pettingill For over a decade, there has been episodic activity from Centers for Medicare and Medicaid Services (CMS) on Liability Medicare Set-Asides (LMSAs), including but not limited to, policy memorandums, Medicare Learning Network announcements, a notice of proposed rulemaking with subsequent withdrawal, an advanced notice of a notice of proposed rulemaking as well…

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WCMSAs and Non-Submit Programs

B. Josh Pettingill Many carriers are moving to “non-submit programs” using Evidence-Based MSAs as the driving force for the change[i]. Getting approval of a Medicare Set-Aside is never required by any law or statute. There are times when not submitting the Workers’ Compensation Medicare Set-Aside (WCMSA) makes sense in order to achieve a resolution. Most…

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The Interplay between Medicare and Medicaid for Injured Workers

Jason D. Lazarus, Esq. This blog post will discuss dual eligibility for injured workers.  It will address exactly what it is and how Medicaid coordinates with Medicare for those that are dual-eligible.  Finally, it will talk about the techniques to preserve Medicaid and Medicare. Some individuals are “dual eligible” meaning they qualify for both Medicaid…

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Injury Victim Gets Part B Denial of Care by Medicare

Jason D. Lazarus, J.D., LL.M., CSSC, MSCC In the past, trial lawyers never had to worry about whether Medicare would pay for their client’s future care post-settlement. There is cause for concern that this may not be the case in the future.  Consider this scenario – you represent a current Medicare beneficiary in a third-party…

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Settlement Language Can Make or Break a Workers Compensation Case

B Josh Pettingill Appropriate settlement language can make a significant impact on the total amount of the workers’ compensation settlement, as well as dollars that the injured worker receives. This brief article will provide plaintiff/applicant attorneys with the requisite settlement language to maximize the workers’ compensation recovery, as well as protect their respective firms and…

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Reversionary Clauses and the Impact on Injured Worker

B. Josh Pettingill Reversionary clauses have become a common term of settlement in workers’ compensation cases involving a Medicare Set Aside (MSA). It is important for workers’ compensation attorneys to understand how these clauses can impact the injured worker, as well as the settlement. What is a reversionary clause? A reversionary clause means that when…

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Evidence Based MSAs (EBMAs): Don’t Accept Blindly

B Josh Pettingill Evidence Based MSAs (EBMSAs) have taken the workers’ compensation industry by storm the past several years. It is imperative for workers’ compensation attorneys to understand how EBMSAs can impact both the settlement value, as well as your clients’ benefits post-resolution. EBMSAs can be a cost savings mechanism in resolving a workers’ compensation…

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Liability Medicare Set-Aside (MSA) Case Studies: Eliminate, Reduce & Comply

B. Josh Pettingill There is mounting evidence that the Centers for Medicare and Medicaid Services (CMS) will establish formal guidelines for liability MSAs in the imminent future.  Medicare Secondary Payor compliance related to future medical care is an issue that can’t be ignored but that doesn’t necessarily mean setting up a Medicare Set-Aside on every…

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How to Close Cases Ethically & Compliantly for Disabled Clients

Jason D. Lazarus Suffering even a moderate personal physical injury can create difficult challenges both financially and emotionally for even the strongest among us.  However, what happens when someone suffers a serious or catastrophic personal physical injury causing permanent disability?  Do they get the proper counseling regarding the form of the settlement to protect their…

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Taking Advantage of the WCMSA Re-Review Process

B. Josh Pettingill We frequently receive inquiries regarding workers compensation MSAs (WCMSAs) and whether it is possible to get CMS (Centers for Medicare and Medicaid Services) to re-review an MSA once an amount has already been approved. The good news is that it is possible. However, you only get one opportunity and certain criteria must…

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How to Tell if Your Client Needs a Liability MSA

In a personal injury case, Medicare set aside (MSA) arrangements can be confusing for both the plaintiff and the plaintiff’s attorney. Most personal injury attorneys don’t have the experience to coordinate MSA arrangements for their clients. A lack of experience and knowledge can lead to liability for the trial attorney involved in the case. The…

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SYNERGY MSP Compliance: Protecting Your Firm in 2019

B. Josh Pettingill CMS has established a set timeframe to roll out formal guidelines for Liability Medicare Set-Asides (LMSAs) in 2019[1]. Plaintiff attorneys must develop Medicare compliance protocols for their law firms to avoid exposing them to liability from legal malpractice pitfalls. Plaintiff attorneys must go on the offensive regarding Medicare Secondary Payer (MSP) compliance…

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7 Common Workplace Injuries That Could Require Medicare Set Aside Services

Utilizing a Medicare Set Aside for personal injury can be confusing without the help of an experienced settlement consultant from Synergy Settlement Services. Fortunately, our Medicare Set Aside (MSA) services help attorneys focus on the case at hand by allowing an experienced professional to handle the details of their client’s settlement. It’s easy to get…

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Liability MSAs: Is It Time To Worry? Third Thursday Webinar

Join us this month for a special presentation by Synergy's Vice President, Medicare Secondary Payer Compliance, B. Josh Pettingill, to discuss the Centers for Medicare and Medicaid Services' (CMS) potential regulations on Liability MSAs and best practices for protecting your law firm as it relates to MSP compliance, including Medicare Advantage. A 15-minute question and answer session will follow.