Medicare Set-Aside (MSA) Allocations
PMSI Settlement Solutions pioneered Medicare Set-Aside (MSA) allocations in 2001 and was the first company to integrate Medicare Set-Asides with a comprehensive pharmacy and clinical program to provide proven cost containment methodologies for MSAs. As a leading pharmacy benefit manager and long standing MSA expert, our cross-disciplinary team of pharmacy, medical, claims, and legal specialists produce allocations that you can feel confident in. PMSI’s MSAs help you efficiently and cost effectively close claims while complying with all Medicare Secondary Payer (MSP) regulations. PMSI Medicare Set-Asides deliver:
- Accurate, lowest defensible allocations
- Compliance with the MSP and CMS guidelines
- Independent multi-disciplinary analysis of each claim
- Rapid turnaround
- Single point of contact for all MSA related questions
- Free Rated Age to lower total allocation
- In-house expertise to handle all MSP compliance concerns
- Optional Drug VALUE Review, a comprehensive medication utilization analysis to futher reduce allocations
- Special handling per client request
Workers’ Compensation Medicare Set-Aside (MSA)
All-inclusive solution for workers’ compensation claims to ensure MSP compliance. Includes a comprehensive medical write-up, documentation of non-Medicare covered items/services, Rated Age determination, and the overall lowest defensible allocation.
Liability Medicare Set-Aside (LMSA)
Comprehensive allocation specifically designed to provide auditable documentation of compliance with MSP regulations on liability claims. A detailed report with a comprehensive medical write-up and documentation of all liability-specific aspects of the claim is provided. An LMSA includes Rated Age determination and results in the overall lowest defensible allocation.
MSA/LMSA Support Services
Social Security Verification
Upon receipt of a case assignment accompanied by a properly executed Social Security Release form, PMSI will determine Social Security Disability and Medicare status with the Social Security Administration. Based on the result, the need for an MSA/LMSA allocation is determined. PMSI then notifies the client of the status and provides appropriate recommendations regarding MSP compliance.
CMS Approval
Once PMSI has completed the MSA/LMSA and received a request from the client for CMS review and approval, the necessary documentation is prepared and submitted to CMS. This service includes resubmission of the case to CMS for reconsideration, if necessary.
Second Opinion
A quality MSA ensures Medicare’s interests are protected while containing your costs. PMSI’s MSA experts can re-evaluate an MSA/LMSA allocation completed by another provider to ensure accuracy and that the lowest defensible allocation has been provided. There is no risk to you—if we cannot reduce the allocation, your second opinion is free.
To see other services PMSI offers to reduce settlement costs, click here.