Synergy’s MSP360° suite of services gives you access to a team of experts who can evaluate your client’s case, advise you about the difficult and ever-changing terrain of the MSP landscape, and be your guide to total Medicare compliance. We provide the following services to attorneys nationwide for workers’ compensation claims, liability claims, medical malpractice, Longshore and Harbor Worker’s Compensation Act (LHWCA) claims, Jones Act claims and FELA railroad claims. Our services will put you into control of the Medicare process instead of leaving it in the hands of the defense so that you can speed up settlements involving Medicare beneficiaries by demonstrating to the other side that compliance issues have been addressed.
- MECE Service
- Medicare Compliance Audit
- Medicare Set-Aside Allocation
- Medicare Set-Aside Professional Administration
- Medicare Set-Aside Independent Analysis
- Liability MSA Case Consultation
- Liability MSA Reduction Analysis
- Non-Medicare Expense Evaluation
- Medical Cost Projection Report
- Case Review
- WCMSA Submission
- Mediation Attendance
- Structured Settlement Services to Fund MSA
- Documentation Review
- Medicare Conditional Payment & Medicare Advantage Lien Resolution
If you represent a client who is Medicare-eligible and is likely to continue to treat post settlement, we recommend a Medicare Expert Case Evaluation (MECE) when you resolve the case.
MECE is a case specific video conference or telephone consultation to educate the client on Medicare’s potential interest in the settlement. It includes customized options for “future interest” protection mechanisms. Should the client decline to create a recommended Medicare Set-Aside (MSA) after consultation, we will prepare a customized waiver for the client to sign to document that election.
Medicare Compliance Audit
Avoid potential delays at settlement caused by Medicare compliance issues with the defense. Arm yourself with Synergy’s MSP Compliance Audit Report. Doing so demonstrates that you and your client have appropriately considered Medicare’s potential interest in the settlement. Take control of the MSP compliance process and prevent unnecessary complications in finalizing the settlement by providing Synergy’s proprietary audit report to the other side.
This audit service arms you with documentation to show complete compliance with the Medicare Secondary Payer obligations in your case. The services include an initial diagnostic consultation with a Medicare expert, an initial assessment of the conditional payments through the Medicare Secondary Payer Recovery Portal, the identification of appropriate ICD diagnosis codes for coordinated Section 111 reporting in the case, MSP compliance settlement language templates and a final audit report confirming complete MSP compliance in the case.
Medicare Set-Aside Allocations (MSAs)
We provide a detailed analysis of the future medical needs for an injured party over life when we create our allocation recommendations. Our litigation nurse consultants and life care planners work to ensure an accurate and justifiable position to present to the Centers for Medicare and Medicaid Services (CMS)when CMS review is available and requested by the parties
Medicare Set-Aside Professional Administration
There are major complexities in administering a Medicare Set Aside once established and funded. We offer professional administration services through a trust arrangement or custodial agreement. Professional administration gives the injury victim a trusted resource for proper administration of the set aside. We provide the injury victim with the comfort of knowing they have an expert that will determine what is Medicare covered; audit medical billing (cost containment); pay the proper rates and provide a detailed accounting of the use of the funds to Medicare. Professional administration is done in compliance with the guidelines set forth by the Centers for Medicare and Medicaid Services (CMS) for administration of a MSA which helps protect future eligibility for Medicare benefits. These services include preparation of the Medicare Set Aside Trust/custodial agreement; establishment of set aside trust/account; auditing of medical bills for cost containment; communication with medical providers & negotiation of bills; payment of Medicare covered services from the MSA trust/account; notice to CMS of temporary exhaustion of funds resulting in Medicare becoming primary coverage and accounting/reporting to CMS regarding the expenditures from the set aside.
Medicare Set-Aside Independent Analysis
To ensure that Medicare’s interests are properly addressed by the opposing party’s set aside allocation; we can do an independent review of the proposed Medicare Set Aside allocation. Having an independent analysis will help counsel decide whether the proposed set aside by the opposing party is sufficient.
Liability MSA Case Consultation
The Medicare Secondary Payer Act is a complex piece of legislation with far reaching impact. We can provide advice on adequately considering Medicare’s interest under the MSP in a liability case and whether or not an MSA should be utilized in order to protect your client and firm.
Liability MSA Reduction Analysis
If a liability Medicare set-aside analysis is performed, Synergy can provide a proprietary reduction analysis that takes into account a limited recovery to reduce the amount of the set-aside.
Non-Medicare Expense Evaluations
We can provide a detailed analysis of costs that will not be covered by Medicare. Having this information allows counsel to quantify what the MSA will not cover and present that figure to the defense. This analysis can help increase the value of the claim by quantifying how much care is not covered by the MSA.
Medical Cost Projection Report
We can provide a detailed analysis of the future medical expenses to be incurred by the injury victim. Similar to a life care plan, without the same expense and some of the detail, this report is used to quantify future medical care.
As part of our case review service, we can perform a Social Security and Medicare status determination. We can determine whether a case meets CMS / MSA review thresholds. We assist attorneys in preparing all necessary documentation and help with any required language that must be in settlement documents.
We prepare the formal MSA submission package for CMS to assure proper compliance under the Medicare Secondary Payer Statute. We also provide post-MSA submission follow up and communication with CMS, as well as ongoing submission updates to our client. At this time, CMS is only providing review of Workers’ Compensation Medicare Set-Asides that meet CMS’ voluntary review thresholds.
A consultant will attend mediation and settlement conferences at no cost. We help educate and advise injury victims about MSA funding options. We help attorneys advise their clients about settlement planning financial issues and options.
Structured Settlement Services to Fund MSA
A complete set aside solution also requires the use of structured settlements to fund MSAs. We can provide a comprehensive funding analysis of our set aside allocations or any competitor’s allocation.
We assist attorneys in preparing all necessary documentation and help with any required language that must be in settlement documents.
Medicare Conditional Payment & Medicare Advantage Lien Resolution
Medicare may make a conditional payment when there is evidence that the primary plan does not pay promptly conditioned upon reimbursement when the primary plan does pay. When Medicare does make a conditional payment, Synergy can resolve the claims against the settlement by Medicare including compromise & waiver requests.
Medicare Advantage plans have the same right to recover as traditional Medicare. Medicare Advantage Organizations (MAOs) are handled by private insurance carriers. Synergy can report the liability claim, audit and dispute claims for unrelated care and negotiation of the final amount to be repaid.
We offer free CLE training to help you understand the complexities of the Medicare Secondary Payer Statute. We are your trusted partner in MSP compliance.
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The Synergy Settlements team will work diligently to ensure your case gets the attention it deserves. Contact one of our legal experts and get a professional review of your case today.