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Medicare Secondary Payer Services (MSPS)

Medical Cost Containment

Medicare Secondary Payer Services (MSPS)

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Medicare Secondary Payer Services (MSPS) Centers for Medicare and Medicaid Services (CMS) maintains guidelines for Medicare Set Aside (MSA) Workers’ Comp and Liability including updates, submissions, medical cost projections (MCP), life care plans, MCP to MSA conversion, Conditional Payment Identification, Conditional Payment Dispute/Resolution, Final Document Submission, Medicaid Services, Medicaid Dispute/Negotiation, Medicare Check. Social Security Disability Verification and Rated Age Evaluation. SFUR utilizes a combination of Registered Nurses, Certified Life Care planners and or Certified Medicare Set-Aside Consultants to handle this process.

Summary

Medicare Set Aside (MSA) Workers’ Comp and Liability process projects injury-related Medicare covered medical treatment, services and prescription needs over the claimant’s life expectancy.  This process identifies areas of cost saving while providing an  allocation for future injury related medical care and future pharmaceutical needs.

Since 2001 insurance companies have used the Worker’s Compensation Set Aside agreements to rectify cases that involve Medicare beneficiaries with a future medical component. This benefits the insurance company and SFUR delivers this capability at very competitive rates.

Example

Conditional Payment Identification payments arise when an injured worker is a Medicare Beneficiary.   Any injury related payments that are made by Medicare are made in expectation of reimbursement.

SFUR works with the Coordination of Benefits and Recovery Overview @ Centers for Medicare (BCRC/CRC) in this process.   Once a CMS case identification is assigned, SFUR will request a Conditional payment Letter (itemized summary of CMS charges for reimbursement), update Conditional Payment amounts and review of charges for dispute recommendations. A conditional payment will continue to fluctuate as providers submit and Medicare payments are made.