Services Provided

• Determination of whether a Medicare Set-Aside (MSA) is appropriate and whether it requires approval based on criteria established by The Centers for Medicare and Medicaid Services (CMS);
• Acquisition of appropriate CMS release form and authorization;
• Acquisition and review of medical records for the last 3 to 5 years;
• Acquisition and review of medical/prescription/indemnity payment history;
• Establish life expectancy;
• Communication with treating providers to determine future medical management expenses;
• Comprehensive drug review and recommendations to achieve maximum cost effective drug utilization and savings;
• Prepare report with medical summary, including initial information, current treatment, future needs, and pre-existing and/or comorbid conditions;
• Future medical cost projection of Medicare and non-Medicare expenses related to work injury;
• Determination of Medicare Set-Aside allocation over the life expectancy of claimant;
• Compilation of all necessary supporting documentation required by CMS;
• Coordination with structured settlement broker and professional administrator, where appropriate;
• Submission of Medicare Set-Aside along with required documentation;
• Exchange information and provide requisite materials for approval of allocation from CMS;
• Acquisition and review of “conditional payment” lien letter from Medicare;
• Review and analysis of “conditional payments” to determine work-relatedness;
• Post-redemption hearing communications with MSPRC to ensure that all post-redemption hearing conditional payments have been satisfied.