is an arrangement between the settling parties and required allocation by law where both the plaintiff’s counsel and the defendant’s counsel must protect Medicare’s interests when settling future medical benefits for qualified individuals. This required allocation prevents the shift of burden from the primary payer to Medicare.
All KRS MSA reports are evidenced based and readily defensible in a court of law.
KRS MSA utilizes their proprietary web based platform FLUENT Systems® to provide unrivaled consistency adhering to an evidenced based approach to our valuations. FLUENT Systems'® is the premier software provider for companies who prepare Medicare Set-Asides, Medical Cost Projections, Life Care Plans and or MMSEA Sections 111 MSP Mandatory Reporting. FLUENT Systems® is not just another Software As A Subscription service. KRS MSA’s one of a kind web & data-base driven, medical code and data integrator produces a number of federally mandated templates which has standardized the line of action for evaluating future medical care for a Medicare beneficiary or Medicare's current financial interest. An RN completing an MSA would tell you that the workflow involved is arduous, time consuming and painstakingly detailed. Thanks to FLUENT Systems® the overall operational efficiency has increased by over 10 times the norm and CMS ready reports breed elite level consistency, appropriateness and compliancy whether a company requests a Basic MSA, Complex MSA or a Medical Cost Projection. With over 5,000 submissions to CMS, our Acceptance Rate for a 1st time submission is over 99.4% which is unmatched in the insurance space! All Reports include the doctor's notes and treatment plans to ensure that CMS compliance & treatment guidelines are adhered to. Allocations are broken out by Anticipated Medicare Costs and Anticipated Non-Medicare Costs. All reports will be prepared by an experienced MSCC Certified Nurse and meet 100% TQC (Total Quality Control) Standards. As a failsafe, a Quality Control Manager must execute a written approval before a report can be delivered to a customer. This maximizes a best foot forward approach that KRS MSA prides itself in!
Karen Cofield, RN, CCM, QRP, MSCC, CMSP, a NAMSAP Member, founding member of KRS MSA, and a Nurse Case Manager with Fireman's Fund and Liberty Mutual brings over 25 years of experience working with CMS in delivering consistent, qualified and reliable Medicare Set Aside outcomes! Karen has worked with attorneys, case managers, adjusters, and regulators to define and refine the necessary reporting and administration. Over a decade ago Karen co-found FLUENT Systems®. Karen assisted in architecting this one of kind MSA software system all the while creating and providing the necessary logic, formatting, information, due diligence and finally the blood, sweat and tears that went into this propriety software company! In the end KRS MSA produces and delivers a MSA or MCP report which is a required (in most cases) settlement evaluation tool architected to protect the fiduciary interest of CMS when CMS is not the primary insurer. The CONCLUSION is a ONE OF A KIND SETTLEMENT REPORT which is ACCURATE (*WE GUARANTEE IT - WANT TO BET A FILE ON IT?), CONSISTENT and DELIVERED IN LESS THAN 5 BUSINESS DAYS (on average…DID I MENTION WE GUARANTEE IT?)
In preparation of a liability, personal injury, or no-fault case, we recommend including design factors which consider Medicare’s interest. There are mounting indications that CMS will establish formal guidelines for liability settlements in the near future. Prudence implores that protecting Medicare’s interest be considered necessary on any settlement involving a Medicare beneficiary. Our highly experienced Medicare Set Aside Certified Consultants and Registered Nurses address regulatory and medical aspects of the MSA. We identify and implement cost saving solutions for the MSA. KRS MSA's experience and technology identify and suggest efficient cost savings solutions for all MSAs. KRS MSA’s reports utilize accepted rated ages and structured settlements to produce best evidence analytics and conclusions.
Pursuant to 42 U.S.C. Â§1395y (b) (2) (A) (ii), CMS/Medicare is the secondary payer in all workers compensation, no-fault and general liability claims. Under the Medicare Secondary Payer Act (MSP), CMS has taken the position that they are the secondary payer regardless of liability and they have a statutory right of recovery against all parties, including law firms involved in the claim, related to their past interests and/or future interests.
Prior to 2011, CMS policy memoranda were directed at workers’ compensation plans. In May 2011, Sally Stalcup, CMS’s Region VI (Dallas) MSP Regional Coordinator issued a general memorandum regarding Liability Medicare Set-Asides (LMSAs). In this memorandum it was noted that, “Medicare’s interests must be protected; however, CMS does not mandate a specific mechanism to protect those interests. The law does not require a ‘set-aside’ in any situation. The law requires that the Medicare Trust Funds be protected from payment for future services whether it is a Workers’ Compensation or liability case. There is no distinction in the law.”
The memorandum was followed in September 30, 2011, by a statement regarding MSAs in non-workers’ compensation case by Charlotte Benson of CMS/Office of Financial Management. Cases where Medicare’s Interest should be considered in Liability claims
🚨 Cases where future medical expenses are being considered in the settlement;
🚨 Cases involving a Medicare beneficiary or someone who will be entitled to Medicare in the foreseeable future;
🚨 Catastrophic injury cases such as traumatic brain or spinal cord injuries, multiple amputations or cases involving severe psychological components. Long-term medical care and treatment will be presumed by CMS as necessary in these cases;
🚨Structured settlements: Medicare generally takes notice of these settlements given that long-term care may be part of the settlement agreement; and
🚨 Any case in which the injured person will certainly require future medical care and treatment for the injury, exposure or ingestion.
A Medical Cost Projection (MCP) is based on a comprehensive medical report and evaluation designed to help identify potential medical issues or complications and assign a proper value accordingly. Each report will provide a comprehensive financial analysis of both current and future medical care.
Medical Cost Projections are becoming increasingly necessary for Case managers, Adjusters, and Attorneys to manage and administer cases and to help with accurate reserve setting, settlement negotiations and to help determine the monetary value for basic and complex medical care and or surgical procedures.
First notice of Injury/Loss
KRS MSA will obtain rated ages at NO ADDITIONAL CHARGE if needed!
What items are needed if CMS approval is requested?
In addition to the above requirements, we will need the following items to obtain CMS for approval of the MSA:
1. CMS/Medicare General Release signed by injured party
2. Method of administering the MSA (self or professional)
3. Method of funding MSA (annuity or lump sum)