Working with Crowe Paradis: FAQ's:
What are the advantages of working with Crowe Paradis?
-
Legal and Medical review of every file
-
Legal opinion letter
-
We advocate for you on every file, not only on the amount of the MSA, but also on the amount of the conditional payments
-
Two former Medicare recovery contractors on staff who understand how to successfully partner with CMS
-
SSDI database developer on staff for fast turnaround of SSDI/Medicare checks
-
Attorneys on staff who have been working with CMS since 2001
-
Utilization Review nurses on staff who focus on reducing allocations and saving money
What services do you provide?
Crowe Paradis provides its clients with a full slate of MSP compliance services, including:
-
Medicare Set Aside (MSA) allocations
-
Submission of MSA to CMS
-
“Zero Allocations”:
- Based on legal argument (disputed claim)
- Based on medical argument (pre-existing injury, no need for further care, return to baseline, etc.)
-
Liability Case Consultation, Allocation, and Settlement Assistance
-
Social Security / Medicare determination
-
Conditional Payment Analysis:
- Identification
- Negotiation
-
Legal Opinion / Consultation
-
Settlement language
-
Negotiation
-
Prescription Drug Review
-
Physician Peer Review
-
Rush Service
-
Training
- Seminars
- Webinars
- Protocol Development
-
Self Administration Support
-
Professional Administration Services
-
Do you offer a file pick up service?
Yes, we offer file copy and pickup services nationwide at no additional charge. It is our belief that this service benefits both parties and is often combined with training and/or file reviews for a number of our clients. We also have an easy to use online referral method.
How quickly can I expect my claim to be processed?
We promise a turnaround time for processing your claim of 14 business days from receipt of file materials. And we can often do it faster!
Do you offer a rush service?
Yes, we offer a RUSH service.
Our vendor has a one stop shop for professional administration.
Why don’t you?
While this may seem like a simple solution, in our view it is not the best approach. Professional administrators charge a fee on the amount of the money being administered. As a result, it is our contention that this raises at the very least a potential conflict of interest. In other words, the higher the MSA amount the more money is made on the administration. In response to this issue, Crowe Paradis has developed a strategic partnership with Rising Financial Solutions. Rising does not prepare MSA allocations and they have a long history of providing bill review services. So, if you require professional administration or self-administration support services, we are ready to lend a hand without the ethical wrinkle.
I would like to refer a file. What documents do you require?
The following documents are required to prepare Medicare set aside agreement:
-
First report of loss
-
Last two years of medical records
-
Printout of benefits paid (medical, indemnity & pharmaceutical)
-
Relevant legal documents/pleadings
-
Proposed or executed settlement documentation
I have a technical question, do you provide support?
We are sincere about providing a unique response to our clients’ MSP compliance needs and we will support you from initial referral through the crafting of settlement language as part of our base fee. If you have a simple question or would like to discuss the facts of a complex case, we are committed to helping you negotiate the complexities of the MSP statute.
We are also uniquely qualified to provide phone customer service to our clients. Not only can we address general questions and issues involving referrals, but we have a staff of attorneys and nurses available to address complex matters as well. This is one of the few times you can seek the advice of an attorney and not receive a bill!
Why can a guarantee program be problematic?
Offering a guarantee program goes against our philosophy of preserving settlement dollars. We take an advocacy approach to provide the lowest defensible MSA possible, which ultimately translates into considerable savings for our clients. Companies who guarantee an allocation amount may not have your best interest in mind and may in fact take a more conservative approach to treatment and costs to avoid having to fund the difference. We believe this approach leads to higher allocations that may stall settlement costing you in the end.
What is entitled in obtaining a Social Security and Medicare Status determination?
We take the initiative to obtain a signed authorization from the claimant and/or work with the adjuster or counsel to get the proper authorization. With this release, we are then able to obtain a breakout from Social Security detailing both Medicare and Social Security status. Our proprietary approach results in a turnaround time of approximately 3 days from receipt of a signed release.
What is the donut hole?
The use of co-pays and deductibles in the calculation of prescription drugs is commonly referred to as the “donut hole.” We believe that use of the donut hole is a proper, legal, and defensible position that can be creatively used to save thousands of dollars on every claim. The legal authority for applying the donut hole to the claimant’s future prescription drug allocation is found in the CMS Policy Memos. Under the CMS Policy Memoranda:
“CMS will provide in its written opinion the total WCMSA amount that adequately considers Medicare’s interests with regard to the claimant’s future medical treatment. In addition, CMS’ written opinion will note the submitted prescription drug amount. The CMS’ written opinion will provide the total WCMSA amount, which is a combination of the total future medical treatment reviewed by CMS and the future prescription drug costs noted in the submitter’s cover letter. The parties to the settlement must note the total WCMSA amount in the final settlement agreement. Once the final settlement is submitted to CMS’ COBC, the claimant and all other parties can rely on CMS’ written opinion regarding whether the WC settlement adequately protects Medicare’s interests.” See December 30, 2005 CMS Policy Memoranda at question 4.
CMS does not independently price for prescription drugs. Although the December 30, 2005 Policy Memoranda indicated that CMS would begin “independently pricing” for prescription drugs on January 1, 2007, CMS later reversed this statement. Under its present policy, CMS has indefinitely extended its present review procedures. “CMS will not change its current procedures and will not independently price for future prescription drug treatment in WCMSA proposals. The CMS will provide advanced notification when it plans to begin to independently price for future prescription drug treatment in WCMSAs.”
Therefore, under the present policies, any calculation method that “reasonably considers Medicare’s interests” with regard to prescription drugs will be acceptable. Medicare’s gap in coverage is substantial (Medicare will only pay $1,676.25 of the first $5,726.25 of prescription drugs in 2008) and Medicare’s policies only require that an MSA contain Medicare-covered expenses. Due to the tremendous gap in coverage, in our estimation it would be difficult to argue that the “donut hole” is a “Medicare-covered expense.” Our donut hole approach has been consistently approved by CMS and we have never had a prescription drug allocation rejected where we utilized this approach. See July 24, 2006 CMS Memo.
Do you have to use the donut hole in every case?
No. As our client , the decision to apply or not apply the donut hole rests with you and is an option you can employ to reduce the amount of the allocation.
Could we carve out the donut hole in our report?
Yes, in fact our report details what the donut hole is and how it impacts your case. This way an educated decision can be made on whether or not to take advantage of this tactic.
Do you prepare life care plans?
Yes, we prepare Life Care Plans and projections. Our reports include a complete review of all provided medical records, research of the treatment and diagnoses as needed, a narrative summary of the injury, treatment and implications for the future, and tables detailing the projected future treatment and associated costs.
Ideally analyses are completed after an onsite interview with the patient/family and correspondence with treating providers to obtain or clarify necessary information that may not be contained in the medical records. The time involved in these can vary widely due to the complexity of the case, age of the patient, previous, current and future treatment, volume and clarity of the medical records, and issues that may need to be resolved. Our projections usually include all future costs related to an injury, whether they are covered by insurance or not. Deposition, testifying and related travel costs are not usually included in the cost for the actual Life Care plan.
Do you prepare lifetime medical cost projections?
Yes, we prepare Lifetime Medical Cost Projections. Our reports include a complete review of provided medical records, research of the treatment and diagnoses as needed, development of a narrative summary of the injury, treatment and implications for the future and tables detailing the projected future treatment and associated costs. Unless required to clarify issues, there is usually no contact with the patient or providers. These analyses can be modified to include all costs, or those just covered by a particular coverage (such as WC). These projections do not involve any costs for depositions or testifying, as they are considered an adjuster work product.
How do you handle rated ages?
Because rated ages are a potent cost-mitigation opportunity, our medical experts screen referrals for conditions, impairments, and lifestyle behaviors which would contribute to a life expectancy adjustment from the outset on every referral. We frequently find that pre-existing or simultaneous medical conditions that could not trigger a cost adjustment in the underlying claim can have a tremendous impact on the cost of the MSA. Our independent network of partners assists us in providing rated ages at no additional cost, and is more evidence of our best practices. Our team approach to compliance ensuring the best skill sets and service is delivered in every file.
Back to the Top.
|
