Frustrated with Medicare Set Asides that Preclude Your Ability to Settle Claims?
At Care Bridge International we provide our clients with options to help them settle claims easier and faster than any other solution in the marketplace!
For many injury claims involving Medicare beneficiaries, the ability to settle a claim hinges on the ability to protect Medicare’s future interests with a reasonable valuation.
At Care Bridge International, we have proven that traditional methods used to forecast Medicare Set Asides are flawed and do not reflect the realities of medical care and treatment, post settlement.
Instead, we use machine learning methods based on a robust data set of over 16 million bodily injury claims and over 1 billion medical claim transactions, a technology platform actuary endorsed since 2017.
For Medicare Set Asides, Care Bridge International generates both a Medicare Set Aside for CMS submission, review, and approval AND an Analytic-Powered Medicare Set Aside for voluntary non-submission. This allows our clients options in settling claims to both comply with Medicare AND settle claims. How do we do this?
Both Care Bridge Medicare Set Asides include machine learning forecasts based on thousands of similar claims, but our MSA that is submitted to CMS also includes many of the arbitrary rules and patterns of the CMS process that is used to overfund an MSA.
Case Study :
In a claim involving a Medicare beneficiary who sustained a workplace assault on 10/10/2020, the injured worker was pushed and sustained rib contusions on left side, and a left hip sprain.
The MSAPro (CMS Submission) = $11,166.26
The Analytic Powered MSA (CMS Non-Submission), based on machine learning algorithms = $1,279.02.
Conditional Payment Research showed a $0.00 Conditional Payment owed to CMS.
The Analytic-Powered MSA placed the total settlement value under the $25,000 total settlement value, and the parties were able to settle the claim quickly and efficiently while protecting Medicare’s interests.
The total settlement amount includes, but is not limited to, wages, attorney fees, all future medical expenses, and repayment of any Medicare conditional payments, and payout totals for all annuities to fund these expenses should be used rather than cost or present values of any annuities. Also note that any previously settled portion of the workers’ compensation claim must be included in computing the total settlement amount.
Pursuant to the Workers’ Compensation Medicare Set-Aside Reference Guide approval of a Medicare Set-Aside by the Centers for Medicare and Medicaid Services is entirely voluntary. While recommended, it is not required, and Medicare has established a review threshold and only reviews an MSA based upon the following criteria: (a) The claimant is a Medicare beneficiary and the total settlement amount is greater than $25,000.00; or (b) The claimant has a reasonable expectation of Medicare enrollment within thirty (30) months of the settlement date and the anticipated total settlement amount for future medical expenses and disability or lost wages over the life or duration of the settlement agreement is expected to be greater than $250,000.00.
For settlements which do not meet the CMS threshold for review, an Analytic-Powered MSA offers an economical approach to calculate future medicals and expedite claim closure.
The Analytic-Powered Medicare Set Aside is a data-driven, machine learning based MSA report which incorporates state rules/ guidelines for medical treatment, evidence based medical treatment guidelines and CMS requirements for MSAs according to the CMS WCMSA User Guide. Paired with MSA account administration to protect CMS future recovery for all voluntary non-submissions, the approach delivers a compliant and risk protected approach when choosing not to submit an MSA to CMS for a formal approval.
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