Choosing a Medicare Set Aside Vendor – MSP Compliance

As you weigh the value proposition presented by the various Medicare Set Aside vendors on your panel, we are aware that the differences may seem minimal.

However, the differences between vendors are quite stark when focused on the most fundamental aspects of performance for your caseload. Which vendor saves me the most money on my allocation? Which vendor provides the highest degree of compliance and lowest risk of liability with the MSP statute?

We believe the resounding answer to these questions is Crowe Paradis. With that in mind, we would respectfully request that you add us to your panel and offer your adjusters the chance to choose our best–in-class MSP compliance Program.

Regardless of your response to the programmatic issues raised below, identifying these issues should sharpen scrutiny of any MSA vendor’s program. We believe the questions below underscore the Crowe Paradis difference.

Who actually prepares the MSAs? Crowe Paradis is the only vendor that uses attorneys and utilization review nurses on every single MSA we produce. Other than assuring quality, audit-ready MSP compliance, blending legal advocacy with medical ingenuity may seem like mere marketing spin. However higher craftsmanship of our advocate’s MSA produces not only better quality but lower allocation costs. CPSC has successfully produced hundreds of MSA’s, from our caseload as “zero allocations” so that CMS recognizes no need for any allocation amount. In addition, CPSC has saved our clients over 66%, or an average of $104,000 per claim, off of an original allocation from our competitors. Having just a attorney, or just a nurse, or just a database, or just a former adjuster will get you just a Medicare MSA.

How do you ensure identification and reduction of MSP “conditional payment liens”? Producing MSAs is only half of the scope of the MSP compliance challenge. Although some vendors in the MSA marketplace will conduct conditional payment investigations, only Crowe Paradis weaves this investigation it into every MSA without any additional charge. Rather than merely report the existence of a conditional payment, Crowe Paradis negotiates a reduction whenever the facts or the law present the opportunity. With two former Treasury Department agents who collected these MSP “super liens” driving that process for us, we have not only ensured a stronger degree of compliance, but also have produced significant cost savings for our clients. More than avoiding post settlement surprise on conditional payments, we approach this as a opportunity for advocacy.

What guidance does the MSA vendor provide on what to do with Class III cases? Given Medicare's requirement to consider its interests in every settlement, even when Class I and Class II review thresholds are met, we offer a patent-pending Medicare review product that quantifies when an MSA is advisable and when some other, less expensive strategies will work. Providing this review protocol to each adjuster will save time, unify your compliance efforts, and underscore a commitment to compliance in the event of a CMS audit.

Do you want a life care planner or a utilization review nurse preparing the MSA? While an invaluable skill set, the most effective background for an MSA advocate is not life care planning. CPSC has life care planners on staff but we focus on strong workers’ compensation utilization review experience. Trained to balance future medical needs with the applicability and costs associated with the underlying workers’ compensation statute and the Medicare regulations, utilization review nurses sit squarely in the MSA preparation wheelhouse. None of our competitors even mention utilization review let alone use a utilization review nurse to weave it into every single MSA.

How does the MSA vendor ensure you are capitalizing on offsets available to reduce the allocation? It is crucial to analyze your true “primary payer” status using 3rd party claims, second injury fund involvement, apportionment, and other features of the underlying workers’ compensation statute to submit “zero allocations” and take credits to reduce costs. Without an attorney on the job, the analysis will necessarily be at least second-rate and at best secondhand.

How much guidance does the adjuster get from the vendor after the MSA is completed? A great MSA can be squandered if it is not woven properly into the settlement language and the final negotiations. An additional benefit to the presence of an attorney on every file is the guidance provided directly to defense counsel in everything from final negotiations to settlement language and documentation. A strong workers’ compensation background and boilerplate language do not address every issue that finalization of the MSA may require. In addition, our attorneys will also back our allocations with negotiation with CMS, not leaving your adjuster to justify an MSA that they did not produce.

Aside from turnaround time of the MSA itself, what other efficiencies are offered by the vendor? We are very conscious of the time demands surrounding litigation. From a streamlined, no hassle referral form to a one-page Dashboard summary on the allocation, we strive to save you time throughout the process. We also believe in avoiding the nickel-and-dime approach to billing. We will pick up and copy your file for free. We do not have a three or four-tiered billing structure. We do not charge you for investigation and discovery of the conditional payment lien. We do not charge you for a prescription drug review.

Again, we hope that you will take a moment to consider the larger context of Medicare Secondary Payer statute compliance as a whole. Our focus on total MSP compliance has translated not only to comprehensive, exhaustively documented compliance, but also to significant cost savings. We welcome the opportunity to present our results to anyone within your hierarchy. We also relish the opportunity to go head-to-head with any competitive process with the existing members of your Medicare Set Aside/MSP Compliance panel or your in-house process.

I hope you will consider giving us an opportunity to win your business. If you have any questions, please call me anytime at (866) 630-CPSC.