Demanding More From Your WCMSA Provider to Ensure Medicare Compliance

Posted by Brian Cox on Jul 5, 2016 9:59:11 AM

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Many companies write, evaluate, and offer services for Workers’ Compensation Medicare Set-Aside Arrangements (WCMSAs). Do these companies take into consideration your unique claim circumstances, your company’s risk tolerance and your overall claims management strategy?

Let’s start with a brief overview of the typical WCMSA process and the key details to consider as you choose a Medicare compliance partner.

The basic WCMSA process

To create and submit an accurate WCMSA, Medicare established the following basic set of requirements: that need to be included in each report:

  • A cover letter
  • A Consent to Release (C2R) form
  • Rated age or life expectancy information
  • The life care / future treatment plan
  • The settlement agreement or court order
  • The WCMSA Administration Agreement
  • Medical records
  • Payment history
  • Any supplemental or additional information

While the basic requirements are the same from Medicare’s perspective, how that information is researched, compiled, and presented is (or, rather, should be) unique to every WCMSA.

Just because Medicare’s list of requirements is standard, doesn’t mean your WCMSAs should be treated as a commodity product. As you evaluate a compliance provider, find out how much “filling in the blanks” these providers typically do for clients. Also, inquire about the use of templates vs. customized tailored reports to get a sense of the importance an organization places on accurately completing WCMSAs for their clients. There is a big difference between completing WCMSAs from a cookie-cutter template and delivering a true consultation that provides WCMSAs as part of a holistic Medicare compliance program.

WCMSA Provider, Flagship Services Group

Does your compliance partner do the following?

  • Consult with you to understand your claim strategy
  • Ask the right questions to discover all the salient information
  • Provide a medical analysis based on a thorough case review
  • Provide a pharmaceutical analysis based on efficacy, contraindications, compliance, and Medicare approved uses.
  • Review the case file to identify gaps in information and request documentation as needed to support your strategy.
  • Obtain qualified medical opinions on past, present, and future medical records and needs to ensure every base is covered
  • Manually review bills, payment ledgers, and pharmacy utilization ledgers rather than simply reconciling records
  • Look for opportunities to support your strategy by identifying potential treatments
  • Research evidence-based treatment guidelines to support or discount, helping to keep your costs down

The Flagship difference

Flagship Services Group takes a truly consultative approach to developing every WCMSA. First, we collaborate with you to determine the appropriate time to start the WCMSA or if a WCMSA is even the right solution for you. We also discuss strategy and implement protocols to meet your goals and insure compliance is met. We will consult with you throughout the entire process, and after the report is published and/or submission results are back, to ensure you know exactly what’s going on through each stage of the process.

This approach allows us to tailor the process to the particular case’s needs, ensuring no vital piece of information is overlooked.

We don’t simply write a WCMSA based on Medicare’s minimum requirements or whatever documentation is provided initially. Our aim is to do what’s best for you!

Flagship’s comprehensive Medicare compliance program mitigates your risk whether it’s understanding and following Medicare Secondary Payer requirements, Section 111 Reporting, conditional payment lien resolution, or cost containment services.

With Flagships’ WCMSA process, you’ll receive a thorough, comprehensive review of the medical records, customized services and reports and a thorough, individualized, consultative approach throughout the entire process. We don’t use fill-in-the-blank cookie-cutter templates.

A WCMSA is just one piece in a comprehensive workers’ compensation settlement package. Our unique consultative approach allows for increased quality and ensures Medicare’s trust has been considered EVERY time. You will find that Flagships’ services are efficient with quick turnaround times without sacrificing quality for quantity!

To see how Flagship Services Group makes a difference, view our unique MSA process below, or contact us today.

Learn the Flagship Difference

 

Topics: Compliance, medicare compliance, MSA