Settlement Strategies with Medicare Set-Asides

Friday, March 12, 2010 | 0

By Janis Skiljo-Haris

As certified Medicare set-aside (MSA) consultants since 2005, MedLink has been dealing with Centers for Medicare & Medicaid Services (CMS) settlement issues in workers’ compensation and prepared MSAs utilizing a dynamic and interactive process. During our session at the Making Workers Comp Work Conference (March 11-12 in San Fransico), we plan to share our knowledge of effective strategies that facilitate settlement for cost-effective MSAs.
 
One of the core components in these strategies involves utilizing a multidisciplinary approach that includes multiple parties, such as lawyers, claims agents, employers, and physicians, to develop proactive methods that will mitigate the MSA costs. Collaboration with a multitude of professionals is key to determining the appropriate reasonable and necessary MSA allocations and lowest costs for medical care and prescription medications. Otherwise, the MSA can be too expensive, causing the settlement to ‘blow-up’ and end any ability to achieve resolution.
 
Since Medicare is known to change its policies, it is imperative that you conduct extensive research to stay current with CMS’ guidelines and practices. By putting time to investigate these fluctuating policies, you can establish evidentiary support for claims, which can cover a number of practices including tightening the extensive array of CMS’ treatments, tapering medications, and preventing further surgical intervention on patients.
 
We realize that it can be a frustrating process trying to get approval of your MSAs. While this could stem from the higher number of MSAs being submitted to CMS for approval, or the fact the CMS reduced its regional offices in half from 12 to six, the bottom line is that there are strategies available to help expedite this process, and we would like to share them with you.
 
Aside from the detailed settlement strategies for a final MSA, MedLink encourages 5 initial steps to get your WCMSA approved as quickly as possible:

1) Plan ahead. Do not wait until the eve of settlement or trial to start the approval process. CMS accepts WCMSA proposals with "proposed settlement amounts," so once negotiations start, get the WCMSA ball rolling.
2) Do not wait to take Medicare's interests into account at the end of a case; do so at the beginning. Start the WCMSA projection process as early as possible.
3) We file your WCMSA electronically. It speeds up CMS' processing time because if it’s not filed electronically, CMS will delay the MSA if they have to scan in the entire submission.
4) We submit a complete WCMSA proposal that includes everything on the CMS checklist
5) After we make your submission we follow-up with CMS regularly to ensure that the WCMSA doesn't get lost in the maze.
 
Janis Skiljo-Haris is a registered nurse and founder of MedLink, which offers management, scheduling, and training services to forensic physicians and their clients in the medical-legal system.