WORKERS’ COMPENSATION &
LIABILITY MEDICARE SET-ASIDES (MSA)
ExamWorks Clinical Solutions (ECS) utilizes knowledge and expertise to provide Medicare Compliance services determining a reasonable allocation of injury-related Medicare-covered medical expenses projected over the claimant's life expectancy. A portion of the settlement is then allocated to the Medicare Set-Aside (MSA) in either Workers' Compensation or Liability cases. The allocation ensures that the burden of future injury-related medical care is not shifted to Medicare as a result of a settlement. When necessary, a Prescription and Treatment Addendum to the MSA report is prepared, which empowers the adjuster with the knowledge and documentation to contain and often limit the MSA amount.
The ECS Addendum is a unique tool that advises the adjuster of issues identified from our review of the file that may result in an increase to the MSA amount upon approval (counter-higher). Each Addendum provides clear and concise recommendations for documentation that should be obtained and actions that can be taken to avoid a counter-higher. Consequently, the adjuster can choose to obtain the recommended documentation themselves or refer to our Solutions Center.
ECS offers an aggressive approach to calculating the MSA amount utilizing medical documentation and recognized standards of care criteria to appropriately consider Medicare's interests and obtain CMS approval.
- Allocation figures are produced by our team of in-house compliance experts, pharmacists and Planners who are registered nurses with Life Care Planning credentials and Medicare Set-Aside Consultant Certified (MSCC) designations
- Our staff is comprised of subject matter experts who demonstrate and are capable of defending the adequate consideration of Medicare’s future interest for all types of claims
- Our expertise allows you to submit the MSA to CMS for review and approval, while solidly protecting Medicare’s interests
- Our experienced and proven staff of compliance experts can assist you with a simple and efficient resolution of MSP concerns for Mass Tort claims, saving you time and money