Areas of Practice

Medicare Set-Asides

Preparation of Medicare Set-Aside proposals for workers’ compensation and liability settlements. For settlements that meet the workload review thresholds, voluntary submissions may be made to the Centers for Medicare & Medicaid Services (CMS) for formal review. For settlements that do not qualify for voluntary submission to CMS, the MSA may be relied upon by the parties to the settlement.

Legal Opinion Letters

Legal consultation in cases where a formal MSA allocation may not be necessary or appropriate, including workers’ compensation and liability “compromise” settlements with denied liability, as well as settlements where a zero-dollar set-aside may be indicated. Clients are provided a comprehensive analysis of the potential Medicare Secondary Payer issues, current “best practices” and recommendations for risk management, and documentation of the steps taken by the party/parties to adequately consider Medicare’s interests.

Medicare Conditional Payments

Verification and resolution of Medicare conditional payments pending with the Centers for Medicare & Medicaid Services (CMS).  Any settlement involving a Medicare beneficiary—whether liability or workers’ compensation—may have a potential conditional payment issue.

Verification of a claimant/plaintiff’s Medicare beneficiary status. Establishment of Medicare conditional payment claim. Appeal of Medicare liens, including requests for removal of unrelated charges, as well as challenges based upon waiver or partial waiver for financial hardship, waiver or partial waiver for equity and good conscience, and request for compromise in the best interests of the Agency.

Medical Cost Projections

Medical cost projections provide settling parties a calculation of specific future medical exposure in claims where an MSA may not be necessary or appropriate to the situation. The MCP may be used for settlement negotiations, obtaining settlement approval, and setting insurance reserves.

Section 111 Reporting

Section 111 mandatory reporting services, as well as comprehensive review of Section 111 reporting practices for internal auditing purposes to determine compliance with Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA).

Hourly Consultation

For other issues and situations not specifically addressed above, hourly consultation may be appropriate. Such services may include review of settlement documents, assistance with settlement language, verification of a claimant/plaintiff’s Medicare beneficiary status, review of an MSA proposal prepared by an outside vendor, etc.