| Tier 1 - "No MSA" / MSA Evaluation Letter | Tier 1 - MSA Consultation, Waiver & Acknowledgement |
| If your client is not a Medicare beneficiary, there is no accident-related care or future medicals are not funded as part of the resolution of the claim, we offer a "No MSA" letter for your file. This MSA evaluation letter can serve as evidence that Medicare's interests were adequately taken into consideration. | $500.00 |
| Tier 2 - MSA Consultation, Waiver & Acknowledgement | Tier 2 - Estimate of Medicare Future Covered Services |
| Our service includes a telephone consultation with the client to advise regarding Medicare "future interest" protection mechanisms. If they decline to create a set-aside, we will prepare a customized waiver for the client to sign. If an in-person meeting is desired, and travel time in excess of one hour is required, there is an additional charge of $250.00.* | $1,000.00 |
| Tier 3 - Medicare Set-Aside Allocation | |
| This service includes preparation of a complete Medicare set-aside allocation report that complies with CMS requirements for submission. Normal turnaround time for set-aside allocations is 10 days from the date we receive all necessary documents. If needed sooner, a rush fee will be applied (see below for amount). Set-aside allocation fees include one revision to the report and all consultations. | $2,000.00 |
| Defense MSA Allocation Review | Medicare Set Aside Allocation Submission to CMS |
| This service provides the plaintiff with a report regarding the proposed allocation by the defense. Many times inappropriate items are included in the MSA driving the number upward. We work to determine whether it is possible to reduce the MSA. | $500.00 |
| Non-Medicare Expense Report | “No MSA”/MSA Evaluation Letter |
| This report is prepared for workers' compensation cases to determine what items or services will not be covered by the set-aside. It is an invaluable tool for negotiating a workers' compensation settlement. | $1,500.00 |
| Non-Medicare Allowables Letter | Defense MSA Allocation Review |
| Upon comprehensive review of the medical records and the WCMSA analysis, this brief letter is prepared for workers' compensation cases to determine what items or services will not be covered by the Workers' Compensation Medicare Set-Aside. The purpose of this letter is to help establish damages for purposes of negotiating and workers' compensation resolution. | $500.00 |
| Medicare Set-Aside Allocation Submission to CMS | Non-Medicare Expense Report & Donut Hole Evaluation |
| This service includes preparation of a complete package to present the set-aside allocation for CMS review/approval. Please note that most CMS Regional offices refuse to review and approve liability Medicare set-asides. | $1,000.00 |
| Future Medical Cost Projection | Future Medical Cost Projection |
| This service provides a report similar to a life care plan that outlines all of the future medical needs both Medicare and non-Medicare covered. Please note we do not provide expert testimony similar to life care planners. | $2,000.00 |
| Additional Fees | Additional Fees |
| MSA Reduction Analysis | $500.00 |
| Rush Fee for 72 hours turnaround time | $500.00 |
| Rush fee for 48 hours turnaround time | $750.00 |
| Rush fee for 24 hours turnaround time | $1,000.00 |
| Hourly Charge for Revisions | $250.00/hr |
| Deposition Testimony | $250.00/hr |
| Service for voluminous hard copy of medical records | $50.00 |
| *Cases deemed “catastrophic” by Synergy will have an additional $250.00 fee applied. **Complexity determined at intake. | $50.00 |
