Comprehensive MSA services to support claims settlement
PMSI Settlement Solutions pioneered Medicare Set-Aside (MSA) allocations in 2001 and was the first company to integrate Medicare Set-Asides with a comprehensive pharmacy and clinical program to provide proven cost containment methodologies for MSAs. We continue to innovate by expanding to meet the evolving needs of the workers’ compensation and liability markets in regards to Medicare Secondary Payer (MSP) compliance.
With guidelines issued by the Centers for Medicare and Medicaid Services (CMS) increasing the prescription portion of all MSA allocations to almost half of the total allocation, it has never been more critical to have an MSA provider with in-house expertise to accurately allocate future drug costs. As a leading pharmacy benefit manager and long standing MSA expert, our cross-disciplinary team of medical, clinical, legal and claims specialists produce an allocation that you can feel confident in. PMSI’s MSAs help you efficiently and cost effectively close claims while complying with all MSP regulations. PMSI's Medicare Set-Asides deliver:
- Accurate, lowest defensible allocations
- Compliance with MSP and CMS guidelines
- Independent, multi-disciplinary analysis of each claim
- Rapid turnaround
- Local service representatives available nationwide
- Single point of contact for all MSA-related questions
- Free Rated Age to lower total allocation
- In-house expertise to handle all MSP compliance concerns
- Special handling per client request
Medicare Set-Aside (MSA) Allocations
Workers' Compensation Medicare Set-Aside (MSA)
This all-inclusive solution for workers’ compensation claims ensures MSP compliance. It includes a comprehensive medical write-up, documentation of non-Medicare covered items/services, Rated Age determination, pharmacy utilization review (available upon request), and the overall lowest defensible allocation.
Liability Medicare Set-Aside (LMSA)
This conservative solution is specifically designed to emulate the workers' compensation guidelines from CMS and provide documentation of compliance with MSP for liability settlements. This detailed report includes a comprehensive medical write-up and documentation of all liability-specific aspects of a claim. The LMSA includes Rated Age determination, pharmacy utilization review (available upon request), and the overall lowest defensible allocation.
Liability Specific Allocations
Liability Future Medical Allocation
An aggressive solution that utilizes both a clinical and legal approach to produce a reasonable and accurate future medical allocation based on the facts of each individual case to assist in complying with the MSP Act. PMSI's cross-disciplinary expertise in pharmacy, medical, legal and claims allows us to effectively combine all aspects of cost containment. PMSI utliizes medical and pharmaceutical standards of care, cost-effective pricing, application of the distinct legal facts of each case, as well as other evidence-based mitigating tools. This approach provides for the lowest and most accurate allocation while appropriately protecting Medicare's interests.
Limited Liability Future Medical Allocation
Recognizing that not all settlemetns require the same extensive documenation, this cost-effective report is tailored for situations in liablity claims where the monetary amount of the settlement does not justify the expense of a comprehensive LFMA. This allocation is appropriate for smaller claims while ensuring compliance with the MSP Act. The Limited LFMA is available when the allocation is $15,000 or less and the claimant requires only limited future medical care.
MSA/LMSA Support Services
Social Security Verification
Upon receipt of a case assignment accompanied by a properly executed Social Security Release form, PMSI will determine Social Security Disability and Medicare status with the Social Security Administration. Based on the result, the need for an MSA/LMSA allocation is determined. PMSI then notifies the client of the status and provides appropriate recommendations regarding MSP compliance.
CMS Approval
Once PMSI has completed the MSA/LMSA and received a request from the client for CMS review and approval, the necessary documentation is prepared and submitted to CMS. This service includes resubmission of the case to CMS for reconsideration, if necessary.
Second Opinion MSA
A quality MSA ensures Medicare’s interests are protected while containing your costs. PMSI’s MSA experts can re-evaluate an MSA/LMSA allocation completed by another provider to ensure accuracy and that the lowest defensible allocation has been provided. There is no risk to you—if we cannot reduce the allocation, your second opinion is free.
Catalog of Services
Learn more about PMSI’s comprehensive service offerings for MSAs by clicking on the links below: