Medicare Set-Asides (MSA)

·   Worker’s Compensation Medicare Set-Asides (WCMSA)

·   Liability Medicare Set Asides (LMSA)

·   Evidence Based Medicare Set Asides (EBMSA)

·   Non-Submit Medicare Set Aside (NSMSA)

·   Life Care Planning

·   Future Medical Cost Projection (FMCP) 

Worker’s Compensation Medicare Set-Asides (WCMSA)

The approved Workers’ Compensation Medicare Set-Aside (WCMSA) allocation is the safest method to end exposure to Medicare for future medicals when a claim is settling. Franco Signor understands the Workers’ Compensation Review Center (WCRC) practices and has delivered allocations that allow our clients to efficiently settle claims. The results are unmatched: On average, WCMSAs are approved in industry leading turnaround times. Annually, our total dollars submitted versus total dollars approved ratios set the benchmark for the sector.

The industry has been plagued by inaccurate allocations, development letters, and counter-higher demands from Medicare. Historically, vendors have improperly placed the blame on Medicare for these issues. Franco Signor believes that CMS has issued clear guidelines that should be followed in the approval process. We specialize in preparing Medicare Set-Asides that can be trusted as accurate and within the guidelines of CMS.

Our average WCMSA report is completed in under 2 weeks. This is possible because of our use of proprietary technology that integrates seamlessly with your system, creating an environment that lessens the burden on adjusters. We take the time to examine the cost-drivers in the WCMSA, and address those issues that will trigger development letters or counter-higher demands. This is all completed before submission to Medicare for review. This unique and proactive approach produces accurate allocations that pass the CMS approval process in industry leading turnaround times.

The Industry’s Most Comprehensive WCMSA

Identifies Savings. Proprietary MSA Supplement outlines the cost drivers and issues in the WCMSA.
Aligned. Clinically driven projections aligned with CMS review practices to determine value.
Fast. Turn-around time in less than 2 weeks.
Statutorily Comprehensive. Legal review to address non-clinical factors present in the claim.
Proactive. Avoid Development Letters through proactive front-end record management.
Prepared. Counter-higher requests are minimized by proper preparation of the CMS Submission.
Quick Approval. CMS Approval is achieved in under 30 calendar days on average.
Accurate. Total Allocation Submitted to Total Allocation Approved Ratio that set the standards.
• Increased Closures. WCMSAs prepared by Franco Signor result in settlements with Medicare Beneficiaries.

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Liability Medicare Set Asides (LMSA)

CMS is currently working toward the release of new guidelines for the voluntary review of LMSAs. Typically, when a liability settlement includes a release of future medicals, the Medicare beneficiary and their attorney are responsible to protect Medicare’s interest. New CMS policy may not release liability for primary plans, especially if the Medicare beneficiary or their attorney does not fulfill their obligations. Franco Signor’s LMSA provides maximum protection for all parties involved. The service includes the following benefits.

We specialize in helping our clients protect Medicare’s interest in liability claims. To do so, we rely on existing and “in force” CMS policies and pattern a solution that is reasonable and can be defended to CMS, in order to avoid further inquiries. We understand that each client has a different risk tolerance. By taking advantage of the SMART law, our team of experts can design products to adequately protect Medicare’s interests. Let Franco Signor assist you in developing best practices for your LMSA program.

A Proactive Approach to Liability Claims’ Compliance

Defensible Allocations. Clinically prepared allocations focused on evidence based medicine guidelines.
Comprehensive Legal Approach. Legal review to identify and comment on legal issues related to the claim that support a reduction, based on allocation of
fault principles.
Understanding Medicare’s Perspective. Release review to provide appropriate provisions that are not mere conclusions, but substantive statements designed to demonstrate Medicare’s interest was considered.
Total Resolution. Follow-up on conditional payment obligations.
Data Driven. Consultation on appropriate MMSEA data points to report.

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Evidence Based Medicare Set Asides (EBMSA)

Increase settlement opportunities and eliminate unnecessary Medicare costs with Franco Signor’s Evidence Based Medicare Set Aside (EBMSA).

Franco Signor’s EBMSA is a statutorily permitted product that takes advantage of nationally accepted clinical guidelines to project future medical care for Medicare covered expenses. These guidelines (ACOEM and ODG) provide a reasonable basis to adequately protect Medicare’s interests consistent with a Workers’ Compensation plan’s obligation, as set forth under the Medicare Secondary Payer Act and related regulations. The product does not require Medicare approval and is covered by our insurance from claims that may arise from CMS.

The Standard Features of the EBMSA Include:

Predictability in value. The allocation quoted can be relied upon as a basis for immediate settlement negotiations.
Fast. The allocation can be prepared and delivered in fifteen (15) business days or less, once required documentation is received.
Reliable. Should a claim be presented by Medicare against the Client, Franco Signor will handle all administrative appeals and defense for life.
Safe. Professional administration avoids improper payments that prematurely exhaust the allocation. This decreases the potential for CMS claims.
Saves money. Nationally accepted clinical guidelines are highly defensible when projecting future medical, addressing dangerous prescription usage not permitted for long term use to control pain and legal defenses including state laws limiting the coverage of care.
Protected. Our legal team will defend or prosecute an administrative appeal if Medicare ever claims the EBMSA value to be inadequate.
Preserves your rights. By utilizing the EBMSA, all of your appeal rights will be preserved. A standard WCMSA submission forfeits your rights to any future appeals.

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Non-Submit Medicare Set Aside (NSMSA)

Increase settlement opportunities and eliminate unnecessary Medicare costs with Franco Signor’s Non-Submit Medicare Set Aside (Non-Submit MSA).

Franco Signor’s Non-Submit MSA is a statutorily permitted product that takes advantage of nationally accepted clinical guidelines to project future medical care for Medicare covered expenses. These guidelines (such as ACOEM and ODG) provide a reasonable basis for parties to protect Medicare’s interests consistent with a workers’ compensation plan’s obligation, as set forth under the Medicare Secondary Payer Act and related regulations.

The Standard Features of the Non-Submit MSA Include: 

Predictability in value. The allocation quoted can be relied upon as a basis for immediate settlement negotiations.

Fast. The allocation can be prepared and delivered in fifteen (15) business days or less, once required documentation is received.

Saves money. Nationally accepted clinical guidelines are highly defensible when projecting future medical, addressing dangerous prescription usage not permitted for long term use to control pain and legal defenses including state laws limiting the coverage of care.

Preserves your rights. By utilizing the Non-Submit MSA, all of your appeal rights will be preserved.  A standard WCMSA submission forfeits your rights to any future appeals.

Flexible eligibility. The allocation can be completed for Medicare Beneficiaries as well as Non-Medicare Beneficiaries.

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Life Care Planning

Franco Signor’s clinical team will prepare a Life Care Plan (LCP) using a certified life care planner. The LCP will project future medical costs for claimants with catastrophic medical conditions, addressing the individual issues and variables to ultimately maximize independence and improve quality of life. Our LCP Services are billed hourly.

Future Medical Cost Projection (FMCP)

Franco Signor’s clinical team will project a claim’s medical costs for reserving or determining lifetime medical exposure on a case. Our FMCP Service will identify the primary cost drivers for both medical and pharmacy costs and provide recommendations and management strategies to control the claim costs. Our FMCP Service is billed at a flat rate based on the complexity of the claim.

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For more information about these services, engage us today at: engage@francosignor.com

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