Care Bridge International Scores Unprecedented Outcomes for Medicare Secondary Payer (MSP)

Care Bridge International calculates medical exposure for bodily injury claim reserves, medical damages for litigation and Medicare Set Asides, simply and rapidly, with human compassion and machine learning technology, delivering unprecedented claim outcomes

In 2019, Care Bridge International was retained as an expert witness involving a Worker’s Compensation Medicare Set Aside (WCMSA) produced by the nation’s largest provider of MSP services and upended the outcome of an arbitration between two primary payers. The matter involved an original proposed MSA totaling $501,881.79 with 90% of the total amount due to projected prescription drug costs. In contrast, starting from a common date and using the same medical facts, Care Bridge algorithmically generated an exhibit WCMSA, with forecasted total medical costs of $42,123.18.

The WCMSA was voluntarily submitted and approved by CMS, as-is, without addressing the suspect future prescription drug utilization assumptions, physician recommended tapering, or urine drug screen results.

A medical canvas revealed that within 3 years post-settlement, the claimant ceased to require any prescription drugs for injury related care, consistent with the Care Bridge prescription drug forecast. For prescription drugs, the original WCMSA cost the payers 92% more than medically indicated. Care Bridge also found that the Large Conventional MSP Company failed to identify compensable neck / cervical spine complaints in the MSA, potentially exposing the primary payers to conditional payments.

While it is likely the claimant will never fully exhaust his WCMSA account, based on the Large Conventional MSP Company results, the payers made an over-payment of at least $430,000 and held additional exposure for conditional payments related to the cervical spine (neck), including possible incurred interest, fines and penalties. Additionally, no risk protection was put in place by the settlement parties to ensure the proper spend of the WCMSA and beneficiary obligations. A very costly, Medicare approved, but non-compliant settlement.

Care Bridge International is the industry leader in Medicare Secondary Payer compliance that brought you the first NCCI Annual Issues Symposium Brief: Medicare Set Asides and Workers Compensation in 2014 and delivered industry insights through the Medicare Secondary Payer Workers Compensation Survey in 2016.

In 2018, Care Bridge International, a Business Insurance Innovation Award Winning InsurTech, released a groundbreaking white paper entitled, “Medicare Set-Asides: What is the True Cost of Future Medical Care?”, demonstrating just how much the Property and Casualty industry over-pays Medicare for Medicare Set Asides.

Care Bridge International smashed the mold of a fragmented, slow, costly, settlement- precluding model with a modern-day, fully integrated, risk-protective, analytic-powered approach. Avoid Medicare over-payments. Increase your risk protection. Generate your MSA today, settle your claim tomorrow.

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