Finality in Settlement Resolution
Developed to protect Medicare from having to pay for future medical care after a Workers’ Compensation claim settles with someone who is on or “reasonably expects” to be on Medicare, the Medicare Set-Aside (MSA) Allocation has evolved into many variants since the “Patel Memo” of July 2001. With Medicare receiving MSA data in the Section 111 Reporting feed to coordinate benefits post-settlement, it is critical to identify claims and properly allocate for future medical care. Jorah’s team has been at the forefront of the industry since its inception, developing new solutions to solve the industry’s toughest challenges.
Workers’ Compensation Medicare Set-Aside
Jorah’s team of medical, legal, and claims professionals have been preparing Workers’ Compensation Medicare Set-Asides (WCMSA) since the inception of the industry. Traditional WCMSAs are prepared in accordance with the CMS Reference Guide and are designed to be submitted and approved by Medicare’s review contractor. Our commitment is to provide the lowest defensible allocation prepared in accordance with these standards. Our results speak for themselves with quick turnaround times (TAT), strong first-pass approval ratings, and a low variance in submitted to approved dollars.
Evidence Based Medicare Set-Aside
Our leadership was the first to develop the Evidence Based Medicare Set-Aside (EBMSA). The EBMSA is not designed to be submitted to Medicare, but rather it is based on scientifically validated treatment standards that are at the core of Evidence Based Medicine protocols. EBMSAs provide our clients with a defensible allocation of the claimant’s future medical needs while shielding them from outdated review practices. EBMSAs often reduce costs, save time, and eliminate uncertainty in settlements.
Indemnified Medicare Set-Aside
Greatly resembling the EBMSA, the Indemnified Medicare Set- Aside (iEBMSA) was first developed by the leadership team of Jorah Claims Solutions. Prepared using the same Evidence-Based standard and designed not to be submitted to Medicare for review and approval, the iEBMSA adds indemnification protections for all parties to the settlement.
Compromise/Zero Medicare Set-Aside
A Compromise/Zero Medicare Set-Aside (CZMSA) is designed for claims where there is a fully denied worker’s compensation claim or contested liability. These are not submitted to Medicare for review and approval and allocated zero or a lesser portion of the settlement proceeds to future medical care.
Liability Medicare Set-Aside
The Liability Medicare Set-Aside (LMSA) has been one of the most speculative areas of the MSP compliance market for quite some time. While Medicare has not published any formal review criteria or guidelines for LMSAs, there remains a demand in the market for the LMSA product. Jorah’s experienced team has been performing LMSAs since inception and can help Medicare beneficiaries limit liability for future medical care to a smaller portion of their settlement proceeds when an LMSA is prepared.
Abbreviated Medicare Set-Aside
The Abbreviated Medicare Set-Aside (aMSA) is designed for small dollar settlements with Medicare beneficiaries that are below review thresholds. These are often described as an “MSA-Lite” but are prepared using the same strict evidence-based medicine protocols as our EBMSA, making them accurate and defensible. Clients primarily utilize the aMSA on settlements below $25K.
Pre-MSA
A Pre-MSA is designed to identify the cost-drivers and savings opportunities within the claim before settlement to reduce the Medicare Set-Aside amount before it is submitted to CMS. Jorah’s team will utilize our cost-mitigation strategies with the claimant’s treating provider(s) to address opportunities to reduce the MSA value while ensuring compliance when submitting to CMS for approval.
