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.
If you represent a client who is Medicare-eligible and is treating for their injuries, we recommend a Medicare Expert Case Evaluation (MECE) when you resolve the case.
Medicare Set-Aside Allocations (MSAs)
We provide a detailed analysis of the future medical needs for an injured party along with life expectancy determinations to 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). We will submit the proposed set aside to CMS for ultimate approval, if desired 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; advise 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 Analysis
To insure 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 Case Consultation
The Medicare Secondary Payer Act is a complex piece of legislation with far reaching impact. We can provide advice on adequately protecting Medicare’s interest under the MSP and whether or not an MSA should be utilized
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.
Future Medical Projections
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.
We can provide an economic analysis to quantify the actual costs required every year to duplicate the needs presented in the life care plan. Once we determine the actual cash flows required, we can then determine the cost to fund the life care plan with a lump-sum payment or a financial settlement product. This figure is the present value to provide for the future medical needs of the injury victim as determined from an economist’s standpoint.
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.
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.
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.