Provisional Medicare Set Aside(PMSA)
This abbreviated MSA allocation provides an accurate projection of the future cost of medical care in a workers’ compensation or liability settlement. This product is intended for planning and evaluation purposes in cases where the Social Security Disability status and/or Medicare eligibility status are undetermined. The PMSA will also identify and delineate any and all cost drivers that might be inflating the MSA. This document does not contain a medical chronology and is NOT intended to be submitted to CMS, but can be converted to a traditional MSA.
Clinical Intervention Service
Our Clinical Intervention Service is aimed at gaining clarity from a primary treating physician on recommended treatment or procedures or surgeries, obtaining missing medical documentation, clarifying whether certain medications are currently being prescribed, etc.
Peer to Peer Review
Our Peer to Peer(which includes a Drug Utilization Review) involves treating physician intervention by a like physician to address medically necessary and appropriate treatment and/or medication prescribing as a quality of care issue. In other words, when high prescription costs are a barrier to settlement, we will attempt to recommend alternative medications and ask the physician to sign an agreement that these changes will be implemented. The Peer to Peer can also address other cost drivers impacting the allocation amount.
Our Medicare Set Aside product(Workers’ Compensation/Liability) allows our customers to settle cases with confidence. Our MSA’s produce the lowest, most realistic allocation amounts while providing a report that will withstand CMS scrutiny.
All of our reports include:
- Recommendations to reduce MSA cost drivers
- A Conditional Payment inquiry – included in our pricing model
- 10 business day turnaround time
- Part D pricing verification just prior to submission to ensure accuracy
- Annuity quote, Professional Administration quote and self-administration assistance quote on all MSA’s over $25,000
- Clinical Intervention/Peer to Peer Review options(upon request)
- Rated Age
- Seed Money calculation
- Expedited service(upon request)
MSA Submission to CMS
Once Axiom has completed the WCMSA/LMSA and receives a request from our client for CMS review and approval, the necessary documentation is prepared and submitted to CMS. This service includes resubmission of the case to CMS for reconsideration, if necessary, and following the process through all the way to approval.
Prescription drug pricing can change at any time, which of course can have a significant impact on the overall MSA allocation. Consequently, we re-check all prescription drug(NDC) pricing just prior to submission, and make our clients aware of any pricing changes and the potential need to revise the MSA.
Medical Cost Projection
Our Medical Cost Projections provide the claims professional with an unbiased third-party estimation of the future cost of care. It is a useful tool for setting accurate reserves and can be a key component for settlement negotiations. Medical Cost Projections are for those claims where a WCMSA/LMSA is not yet appropriate.
SSDI/Medicare Status or Conditional Payment Inquiry
Conditional Payment/Lien Negotiation with CMS
Identifying and resolving CMS conditional payments and liens is at the heart of Medicare Secondary Payer Act compliance. Let our professional staff bring resolution to any conditional payment or lien issues your company may have.
Our service includes:
- Confirmation as to whether or not the injured party is receiving Medicare benefits – if so, we will contact the Coordination of Benefits Contractor and report the claim.
- Request Payment Summary from Medicare Secondary Payer Recovery Contractor(MSPRC) and review conditional payment summary.
- Dispute unrelated medical costs and claims.
- Secure finalized demand from CMS – original demand less unrelated medical costs and claims.
- Provide final CMS demand letter – MSP requires payment to CMS within 60 days of receipt of final Demand Letter.
Our Conditional Payment/Lien Negotiation service increases your staff’s productivity by allowing them to focus on core competencies and ensures MSP compliance.
Structured settlements offer many benefits to all parties when it comes to settlement of a workers’ compensation or liability claim file. For carriers and insured’s, a structure can represent significant cost savings versus a lump sum payment. For plaintiffs and their attorneys, a structure represents security and peace of mind.
When a Medicare Set Aside is a component of the settlement, all parties benefit from a structured settlement. Why? A structured settlement adds a layer of protection by minimizing the potential for misappropriation of MSA funds, thereby reducing the threat of Medicare benefits potentially being denied to the plaintiff, and significant potential fines and penalties for the defense.
AXIOM has the experience and expertise to help you through the entire structured settlement process:
- Structured Settlement Quotes: All structured settlement quotes are provided within 24 hours.
- Top-Rated Life Insurance Companies: We have access to all of the major markets that provide structured settlement products. Each structured settlement plan is built on annuities from highly-rated insurance companies as reviewed by A.M. Best, Standard & Poor’s, Moody’s Investors Service, Fitch Ratings and Weiss Ratings, Inc. We will research the market to deliver the best, most advantageous annuity rates and rated age to achieve the desired result.
- Expertise: Our structured settlement consultants are highly trained financial specialists with over 20 years of experience each. Our experts will provide customized solutions, the best value and win-win settlement solutions.
- Mediations: Our structured settlement consultants are available to participate in your mediation to help bring about a mutually satisfactory resolution and settlement of your claim.
- Settlement Documentation Preparation: Our experts will assist with appropriate settlement language verbiage, and handle all paperwork and documentation associated with the structured settlement to ensure compliance with the life companies underwriting guidelines and all appropriate tax codes.