An allocation is the process of determining how much money must be placed in an MSA. Our allocation experts begin the allocation process by performing in-depth evaluations of the injured party’s medical records. Inquiries are then made to medical providers to determine the future medical treatment anticipated for the claimant. Next, a review is conducted of Medicare regulations to determine what part of that treatment Medicare would normally cover because that is the only treatment for which money must be set aside. After the claimant’s life expectancy is established, a projection is then made of the likely expenses for the covered treatment based upon the applicable medical reimbursement fee schedule. This is the amount that should be placed in the MSA.

Our Goal: Getting Center for Medicare and Medicaid Services Approval

Our approval experts provide CMS with all of the relevant facts concerning the claimant’s injury and his or her medical treatment. This includes the basis for Medicare entitlement, the type of injury or illness, the age of the beneficiary, including an evaluation of whether the beneficiary’s condition would shorten his or her life span, prior and future medical needs of the beneficiary due to the injury or illness, and prior and future medical needs of the beneficiary due to pre-existing conditions. This also includes information on the living arrangement of the beneficiary and the level of continued care required, as well as copies of relevant documentation, including a copy of the settlement agreement and recent medical records. Of course, this would also include the proposed MSA allocation taking Medicare’s interests into account, including information as to whether the MSA will be self-administered or administered by a professional.

Our Approval Experts: Taking Responsibility Through Completion

Our approval experts will take responsibility of this process through completion because getting CMS approval of the allocation amount is the only way to insure primary payer compliance and future Medicare eligibility for the claimant. Since a settlement figure can be rejected by CMS because it may seemingly attempt to shift payment responsibility to Medicare, the only way to truly ensure ongoing and future Medicare coverage for the claimant and satisfy all primary payer’s responsibilities is to secure CMS approval of the set aside amount. Otherwise, an unrecognized settlement can affect the claimant’s eligibility for Medicare services and all other parties’ responsibilities regarding same.