MSA Services

MEDICARE SET-ASIDE ALLOCATION SERVICES

The Speedy MSA Staff provide a single point of access of services including: Comprehensive file review to determine if allocation is necessary (no cost), Medicare Set-Aside Allocations (both standard and complex), CMS Submission/Approval, Comprehensive Life Care Plans, Custodial Account Management, Specialized Legal Services and Lien Research and Negotiations.

Our Staff is composed of Certified Life Care Planners, Nurses, Medical Doctors and other highly trained support staff providing over 200 years of Workers’ Compensation experience. We also have a consulting staff of Physicians to review the pharmacological summaries to determine reasonable expectancy of length of time medications are required.

MSA Flat Rate Pricing

Speedy provides true competitive flat rate pricing, irregardless of the complexity of the file or injury type. We can also expedite files at no additional cost to you.

Allocation Turnaround Times

Speedy lives up to its name when processing and completing a MSA allocation. The industry standard is approximately 4 weeks. Our average turnaround time is 14 days. We will expedite a file for you if needed.

Client Services

Our staff is available to personally answer your calls from 8:00 a.m. – 5:00 p.m. EST, Monday – Friday at 1-800-985-3390. Your personal account staff is available after hours.

Continuing Education Training
Our qualified staff will provide you with free in-service training on the Medicare Secondary Payer Statute (MSP). We also offer additional continuing educational courses for your staff at no cost.

PHARMACY UTILIZATION REVIEW SERVICE

Speedy offers as an additional service to the standard Medicare Set Aside Allocation; consultation and file review with a panel of health care professionals to perform a Medical/Pharmacological assessment of the completed report and medical records when deemed necessary. The panel will be made up of licensed and practicing Physicians and Pharmacists/Pharmacological Consultants who will conduct an evaluation of the future medical needs/costs based on nationally published and accepted resources coupled with their opinion regarding necessity and standards of care/practice. Pharmacy reviews will be based on the Manufacturer recommended usage and the Physicians Desk Reference manual.

Statistically approximately 120 actual medications are prescribed over 70% of the time in the treatment of Worker’s Compensation related injuries and illnesses. *

The following focus will occur with review of the file/MSA:

• Review of the Report of Injury
o Nature of Injury
o Details of Injury
o Compensability/Causality
• Age, Gender, Geography
• Medical History
• Occupation
• Surgeries/Outcome
• Treatment plan
• Medications/ history of medication usage

The review will then look at the Medical Necessity of the past, present and future treatments and compare to the Standards of Practice/Care and traditional model resources as in the Medical Disability Guide. The probability of need must be greater than 50% in order to include the projections. It is noted that when treatment is rendered, as in a procedure or medication, it is anticipated that these will be at least partially effective therefore; continuation over a lengthy period of time would be inconsistent with prescribing them.

SERVICES & FEE SCHEDULES

Evaluation of the File to Determine if MSA Allocation is Necessary - No Charge

• Acquire signed release forms from claimant
• Evaluate the necessity of a MSA based on CMS defined MSA criteria.

Medical Cost Projection - Complex – Flat Rate

• Comprehensive projection of future injury related medical costs related to the work injury via WC fee schedule or usual/customary rates. Process includes an intensive file review of medical records and claim payout history to determine future lifetime future medical expenses. The Lifetime Medical Cost Projection provides an effective analysis tool for final claim settlement in a complex workers’ compensation injury.

Medical Cost Projection – Limited – Flat Rate

• Projection of future injury related medical costs calculated at WC reimbursement rates or usual and customary rates. A cost effective analysis useful as a settlement tool or for setting reserves.

Medicare Set Aside Allocation (MSA) – Flat Rate for Basic and Complex

• Includes a comprehensive MSA allocation cost projection of Medicare expenses related to the work injury via WC fee schedule or usual/customary rates, intensive file review of medical records and claim payout history, Social Security and Medicare status determination, Medicare lien search, determination of rated age and life expectancy and a written detailed report in the CMS approved format with medical summary including initial injury information, current treatment, future treatment needs, pre-existing or co-morbid conditions and amount of MSA allocation.

Submission for CMS Approval – Flat Rate

• Includes submission of Medicare Set-Aside allocation along with the required documentation and releases for approval from the Centers for Medicare and Medicaid Services. Ongoing communication with CMS throughout the approval process. Coordination with Structured Settlement Broker and Professional Administrator if applicable.

Expedited MSA Referral – No Additional Charge

• No additional charges for an expedited MSA Referral. Completion within 7 days of receipt of all data.

Pharmacy Utilization Review – Flat Rate

• Includes consultation and file review of the drug utilization history with a panel of health care professionals to perform an assessment of the pharmacy utilization history to identify inappropriate trends in utilization and potential improvements in therapy and cost savings through changes in prescribed medication.

Additional Services

• Specialized Legal Services related to disputed MSA Allocation from CMS are available as needed.