Synergy Blog

A “Tiered Approach” to Medicare Secondary Payer Compliance (MSAs) for “Futures” Exclusively for Liability Settlements

Synergy has developed a tiered approach to MSP compliance as it relates to “futures” exclusively for 3rd party liability settlements.  It is as follows:

MSA Consultation & Waiver Preparation:  $500

MSA “Estimate”:  $1,000

MSA “Estimate” & Reduction Opinion Letter (for cases where there is a limited recovery):  $1,500

Full MSA Allocation (meeting CMS guidelines from WCMSA memos):  $3,000

The first option (consultation & waiver) would be for cases where the client needs to have the issues explained to them and to identify their options.  If they decline, we create a customized waiver for them to sign.  That is the $500 cost.  The second option (estimate) would be for cases that are “small” or where future medical is quite “small” and instead of a full allocation being created to comply with CMS guidelines, an estimate is done.  We prepare the estimate based on a medical summary you provide to us instead of a full review of all of the medical records.  The third option combines the second option with a reduction opinion letter for cases where the recovery is small relative to the total damages.  For example, you recover policy limits of $200k but the value of the case is $2,000,000.  In that situation, we would estimate future medicals that are Medicare covered then reduce that amount down based upon the limited recovery by using an Ahlborn formula.   The final option is a full Medicare Set Aside allocation which is prepared based upon CMS guidelines and after review of all medical records from the date of the accident forward or the last three years.  This method fully protects the client and is as complete Medicare Secondary Payer compliance as you can get.  Synergy decided to offer these services given the realities of many settlements in the liability context.  They provide multiple resolution options for you to protect yourself and the client as much as possible from MSP related compliance issues.

In addition, Synergy offers a Medicare Set Aside Administration program through the use of a trust agreement administered by a corporate trustee and a separate professional Medicare Set Aside administrator. With a Medicare Set Aside Trust, the injury victim has a professional trustee that has a fiduciary duty paired with a set aside Administrator, who handles the medical bill auditing and reporting to CMS. If the trustee or administrator can no longer perform their duties, a new trustee or administrator may be appointed but the fiduciary obligations and creditor protections of the trust remain. Trusts are covered by state trust and fiduciary laws. Synergy’s Medicare Set Aside Administration program is different because it employs a Medicare Set Aside Trust arrangement instead of a custodial agreement like most other professional administration programs. This arrangement provides another layer of protection for the MSA funds.

To learn more about how Synergy can help with MSP compliance, visit www.synergymsa.com and www.synergylienres.com

TESTIMONIALS

"I just wanted to say thanks to you and the entire Synergy Settlement Services team for helping us put together a series of structured settlements and special needs trusts in two complex cases involving significant recoveries. As always, your accessibility, guidance and expertise on a whole host of post-settlement issues is very much appreciated and valued, particularly with respect to the often confusing topic of Medicare set asides. I look forward to our continued collaboration on cases in the future and am very appreciate of the first rate service your company continues to provide to our clients."

Stephan Le Clainche
Formerly of Babbitt, Johnson, Osborne & Le Clainche

"I recently engaged Synergy to assist with a complicated PTD settlement involving a substantial Medicare Set Aside. The claimant’s wife has been providing full time attendant care which is not Medicare covered. The Synergy nurse was able to do a full analysis of non-Medicare covered expenses which far exceeded the value of the MSA analysis performed by the carrier’s contracted MSA provider. The non- Medicare figures became the main focus of the settlement negotiations and more than doubled the value of the case. Although I could estimate the attendant care figures, the nurse added in other items that I would not have routinely considered. I also asked Synergy to evaluate the EC’s MSA as well as their prescription review. Synergy offered insight about the prescription donut hole which I did not have a clear understanding about. Again, their insight and information added a great deal of value to the overall settlement. Not only did I learn from Synergy but was able to educate my clients in the process. These are very complex and complicated areas; I will use Synergy again and again!"

Rosemary Eure
Lancaster & Eure

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