At Teague Campbell, we distinguish ourselves from many of the national MSA vendors by doing the creative, analytical file review and analysis that saves our clients money. We take a responsive and personal approach towards serving our clients, and avoid using a formula-driven, “one size fits all” model. We do more than act like a middle man between Medicare and our clients, and would not simply forward requests from CMS without considering the implications. We keep our clients advised every step of the process, and we are accessible at all times. We strive to provide quick-turnaround on files and keep our clients updated on new MSA developments.
Conditional payments are verified with the appropriate subcontractors of the Centers for Medicare & Medicaid Services (CMS). Any settlement involving a Medicare beneficiary, whether liability or workers’ compensation, will have a potential conditional payment issue.
We can verify a plaintiff’s Medicare and SSDI status (by releases obtained from the plaintiff and filed with either Medicare or the local Social Security office). We can obtain Medicare conditional payment information. We can identify unrelated charges and request removal. There is also an administrative appeals process available, which based upon your circumstances may offer options based on waiver or partial waiver for financial hardship; waiver or partial waiver for equity and good conscience; and a request for compromise in the best interests of the Agency.
Sometimes a formal MSA submission is not possible, but the parties recognize that an MSA is still necessary. In those situations, we offer preparation of a future medical cost projection, which may include both Medicare and non-Medicare covered expenses, as requested. This cost projection may be used for settlement negotiation purposes and may also be relied upon for documentation of the parties’ protection of Medicare’s interests in funding future medical needs from the settlement proceeds.
We are registered to make inquiries and submissions for both workers’ compensation MSA’s and all conditional payment issues via the respective Medicare web portals. With a signed release from the Medicare beneficiary, carrier, and/or applicable plan, we can perform all tasks related to formal Medicare submissions and verifications electronically.
We are able to provide more routine services, such as monitoring the status of a settlement contingent upon CMS approval, then submitting supplemental settlement documents for Industrial Commission approval to close the claim; coordinating the funding of an MSA by structured annuity; reviewing and revising settlement language in both workers’ compensation clinchers and liability releases; and offering attorneys and mediators support as issues arise during the course of mediations.
We offer consultation in cases where a formal MSA allocation is not appropriate by way of a formal “opinion” letter, similar in effect to a coverage letter in an insurance case. We distinguish ourselves in the manner in which we approach these assignments by reviewing with you, the client, your unique set of circumstances and offering a case-specific and fact-heavy analysis. The result is a comprehensive and thorough approach to risk management which documents that all aspects of the Medicare Secondary Payer Act have been properly considered by the settling parties in protecting the Medicare Trust Fund.
With a focused, customized approach, our Medicare team provides clients with substantial cost savings when settling claims involving potential Medicare Secondary Payer issues. Our clients appreciate the experience and accountability we offer in analyzing the complex Medicare issues in Workers’ Compensation and Liability Settlements that many outside MSA vendors simply cannot match. We work with our clients to develop a strategy for addressing and resolving important Medicare issues such as:
Before you make the referral, we will provide an informal consultation to determine what steps need to be taken. If no MSA is recommended, then we can provide an opinion letter for a flat-fee rate to document our analysis. If a formal MSA is appropriate, then we can prepare the MSA and make the submission to the Centers for Medicare & Medicaid Services (CMS) for approval, including zero-dollar allocations. If you only need a future medical cost projection, we can assist in getting this prepared. Knowing your case, from initial claim to ultimate resolution, means measurable results, tailored solutions, and real cost savings.
Please contact us for our latest flat-fee and hourly pricing options.
We offer free consultations, either by phone or email, to identify which of our services, if any, are recommended prior to formally engaging our services. Consider us your “lifeline” during mediation or at any stage of your settlement negotiations.
If a claimant in a workers’ compensation claim is a current Medicare beneficiary, the carrier has certain reporting obligations to the Centers for Medicare and Medicaid Services (CMS). Under Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of…
As we have addressed previously, under the SMART Act, the Centers for Medicare & Medicaid Services (CMS) is required to set minimum Section 111 mandatory reporting thresholds for liability, no-fault, and workers’ compensation claims. The reporting threshold also establishes a…
As workers’ compensation professionals, we are all too familiar with Medicare Set Asides (MSAs) in settlements. But are we required to include a fully-funded MSA in a compromise settlement? According to the Centers for Medicare & Medicaid Services (CMS), the…
Teague Campbell partner Daniel Hayes joined John Cattie for a relevant and timely presentation at the 2018 South Carolina Workers’ Compensation Educational Association’s (SCWCEA) annual conference on Hilton Head Island. Daniel is a certified MSA consultant and had a book…
Although there is still no official procedure for submitting Liability Medicare Set-Aside Arrangements (LMSAs) to the Centers for Medicare & Medicaid Services (CMS) for review and approval, CMS announced in a written release to physicians and medical providers/suppliers that, effective…
According to the July 10, 2017 version of the Workers’ Compensation Medicare Set-Aside Portal (WCMSAP) User Guide, you may now request a reduction in the amount of a CMS-approved workers’ compensation MSA account if you believe the projected care has…
Under the SMART Act, the Centers for Medicare & Medicaid Services (CMS) is required to set minimum Section 111 mandatory reporting thresholds for liability claims, as well as establish a “safe harbor” regarding conditional payment reimbursements. For liability claims, this…
According to a release issued by the Centers for Medicare and Medicaid Services (CMS) late Thursday, June 9, 2016, CMS is again considering expanding its voluntary Medicare Set-Aside Arrangements (MSA) review process to include liability insurance settlements. Per the official…
Medicare Issues in Liability and Workers’ Compensation Settlements by Daniel W. Hayes, J.D., M.S.C.C., was written to guide practitioners through their analysis of how to best consider Medicare’s interests when resolving claims involving medical exposure. The book is presented from…
Teague Campbell’s Medicare Settlement Solutions recently obtained a favorable MSA approval from CMS in a case where the plaintiff sustained a compensable back injury in 2002.
Medicare isn’t the only entity who can sue you for conditional payments – plaintiffs can too!
Daniel Hayes and Tracey Jones presented at the NAMSAP Regional Meeting held in Orlando on January 29, 2015. Their panel discussion, “Protecting the Client,” covered best practices from both the plaintiff and defense perspectives for tackling Medicare Secondary Payer issues…
We recently learned that the Centers for Medicare and Medicaid Services (“CMS”) withdrew a set of proposed rules which were meant to establish guidelines for liability Medicare Set-Aside considerations. This may not have been so much a function of CMS deciding…
Introduction When resolving a liability claim involving medical treatment, the parties are required by federal law, pursuant to the Medicare Secondary Payer Act (MSP), 42 U.S.C. 1395y(b)(2), to consider Medicare’s interests with regard to the settlement of the medical portion…
