2019 PARMA Panel Discussion: MSAs and Non-CMS Submissions


 

SESSION SUMMARY: The Art of Non-Submission (Medicare Set-Asides and Non-CMS Submissions)


Public Agency Risk Management Association (PARMA) 45th Conference & Expo - FEBRUARY 2019

 

Panelists:

  • JAKE REASON, Vice President of Medicare Set-Aside Services at EK Health Services, Inc.
  • NEGAR MATIAN, Managing Attorney at Matian Law Group
  • DeANNA SORIA, Risk Manager at City of Huntington Beach

 

Panelists discussed Medicare Set-Asides and Non-CMS Submissions in the session titled: The Art of Non-Submission. Below is a list of key takeaways and recommendations from this panel discussion: 

 
If you re going to submit an MSA to CMS: 
  • Make sure you understand exactly what CMS is looking for in terms of a future medical allocation
  • Make sure you've identified any potential problem areas in the medical record/payment histories so there are no unwelcome surprises
  • Make sure you have complete documentation (medical records, claims payment histories, pharmacy payment histories, court documents, etc.) to ensure there are no delays
  • Make sure all parties understand the process CMS uses to review MSAs

 

If you are not going to submit an MSA: 
  • Make sure you have a robust program in place to ensure you're completing an accurate assessment of future medical needs
  • Make sure you have a sound clinical program in place to make full use of evidenced based medical guidelines
  • Ensure you have a method to accurately calculate future medication and medical costs
  • Ensure to consulate with your legal team to appropriately assess the risk of non-submitting

 

In either case: 
  • The use of structure settlements can greatly reduce the overall cost of settlement and can provide significant benefits to injured workers
  • The use of professional administration greatly reduces the risk of the claimant losing their Medicare benefits as a a result of the MSA no being spent appropriately
  • Professional administration provides very specific benefits to injured workers and ensure settlement funds allocated for future medical care are appropriately spent
  • Through the use of custom networks, professional administration increases injured workers' buying power and ensures settlement funds allocated for future medical go as far and last as long as possible

 

 

 - Jake Reason
   EK Health VP of Medicare Set-Aside Services