MSA RiskPro - Newsroom

Recent Claim Settlement Solutions

Workers Compensation Medicare Set-Aside (MSA)
Our client asked us to assist them on a case that was originally reserved for $520,000. With our lien verification and negotiations, we were able to reduce the claim reserve to $150,000. The Medicare Set-Aside (MSA) amounted to $10,000 and the remainder of the claim settlement amounted to $140,000. We were able to produce a savings of $370,000, or 71%, from the original offer and potential future Permanent Partial Disability (PPD) lifetime benefits that would have been paid if the claim never settled.

Workers Compensation Medical Cost Projection
In a recent case, our review indicated that the case would have cost another 30 years of lifetime benefits, or over $624,000. With our Settlement Solutions including the Medical Cost Projection of $12,000, the final settlement amounted to $147,000. This was a savings of $477,000, or 76%, from the original offer and potential future Permanent Partial Disability (PPD) lifetime benefits that would have been paid if the claim never settled.

Auto Liability Medicare Set-Aside (MSA)
We were asked by our client's attorneys to assist them in a case involving a very substantial liability claim settlement. We produced a favorable Medicare Set Aside, and the client is now able to manage their assets and account for their MSA with our assistance. The client and their family have been relieved that they will be able to preserve their eligibility with Medicare when the MSA funds have been exhausted.

Latest Medicare Set Aside (MSA) News

Workers’ Compensation Review Contractor (WCRC) / CMS Backlog Tops 10,000 Cases; Liability (LMSA) is Quicker

As some of you may have recently heard, the Workers’ Compensation approval process is taking on average 180 days as compared to the normal average of 90-120 days.

Our review of the process revealed that the CMS’s Worker’s Compensation Review Contractor(WCRC) is presently going through a massive transition which is resulting in slow turnaround times. The current WCRC vendor operating at the Workers’ Compensation Review Center has been working on a series of 90 day emergency extensions since the 4th quarter of 2010. As you know, the volume of cases needing CMS approval has increased substantially. We continue to monitor this situation and remain in close contact with the Centers for Medicare and Medicaid Services (CMS) to determine when this issue will be resolved. On the flipside, Liability case (LMSAs) approvals are about the same time frame as last year. They bypass the WCRC and go directly to the designated CMS Regional Office (RO). The Approval times on Liability cases are anywhere between 30-45 days assuming there is no request by CMS Regional Office (RO) for additional information. Again, we will continue to obtain the latest developments and share with you as they come available.

HHS Secretary Kathleen Sebelius Announces Delay of ICD-10 until October 1, 2014

WASHINGTON – In a press release from HHS on April 9, 2012, Secretary Kathleen Sebelius announced a proposed rule that would delay the compliance date for ICD-10 from October 1, 2013 to October 1, 2014. The ICD-10 compliance date change is part of a proposed rule that would adopt a standard for a unique health plan identifier (HPID), adopt a data element that would serve as an “other entity” identifier (OEID), and add a National Provider Identifier (NPI) requirement. The proposed rule was developed by the Office of E-Health Standards and Services (OESS) as part of its ongoing role, delegated by HHS, to establish standards for electronic health care transactions under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). OESS is part of the Centers for Medicare & Medicaid Services (CMS). Click here for the full press release >>

Miami-Area Resident Pleads Guilty to Participating in $200 Million Medicare Fraud Scheme

WASHINGTON – A Miami-area resident pleaded guilty today in U.S. District Court in Miami for her role in a Medicare fraud scheme that resulted in the submission of more than $200 million in fraudulent claims to Medicare, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS). Click here for the full story >>

For additional Breaking News related to Medicare, please click the link below:

Breaking Medicare News >>

Our Newsletters

Please visit our recent newsletters for helpful information related to Medicare Set Asides. If you would like to receive future newsletters, please send us a message in the Contact Us section of the website.