Medicare Services & Medicare Claims

Insurance carriers, third-party administrators, self-insureds, and attorneys use our services nationwide for workers’ compensation claims, liability claims, Longshore and Harbor Worker's Compensation Act (LHWCA) claims, and railroad claims.

• Medicare Set-Aside Allocations (MSAs) - Our combined medical and legal approach to Medicare compliance is unique to the industry. Every file begins and ends with an attorney's review to ensure compliance with both state and federal law. Our experienced Medicare industry nurses work hand-in-hand with our counsel to ensure an accurate and justifiable position to present to the Centers for Medicare and Medicaid Services (CMS). As part of the process, Crowe Paradis will also provide CMS submissions and negotiation services.
  
  
• Conditional Payment  Investigation/ Lien Reduction Services – We perform conditional payment investigations, negotiations, and appeals. This is a complex process which we have been able to decipher resulting in considerable savings to our clients and ensuring full MSP compliance.
  
  
• Reallocations –We have performed a number of reallocations to evaluate cases that were not resolved due to high allocations provided by our competitors. Our statistics for reduction in these cases are staggering saving our clients more than $104,000 or 66% off of our competitor's calculation with an equally impressive approval and
  settlement rate.
  
  
• Liability Case Consultation – The Medicare Secondary Payer Statute applies to workers’ compensation claims and to liability claims. We work directly with the parties to ensure compliance and expeditiously resolve these more complex claims.  Our business model of utilizing Medicare Set Aside attorneys on every claim makes our liability case consultation not only effective but seamless as well.
  
  
• Custodial Accounts – A complete Medicare solution requires the use of custodial accounts to hold the funds designated for future medical care on occasion. We will work with you to evaluate cases to determine when this is reasonable and/or necessary and craft the right solution for your individual case.
  
  
• Structured Settlements – A complete MSP Compliance solution also requires the use of structured settlements to resolve claims. We have strategic relationships with settlement brokers nationwide to assist us in expeditiously resolving your claims.
  
  
• Protocol Design –Our team of experienced attorneys and nurses will work directly with you to design protocols and implement policies to not only reduce risk but also save money. We have worked with a number of carriers, third-party administrators, and self-insureds nationwide to craft a solution to their Medicare compliance issues in both workers' compensation and liability claims.
  
  
• Training – Among the resources we bring to the table is a unique ability to assist in training to help you understand the complexities of the Medicare Secondary Payer Statute. Within our team is Robert Lewis who has been actively involved in training professionals nationwide through MediPro Seminars L.L.C. and the University of Florida.