Healthcare Resource Group

All organization working with a claim have responsibilities under the Medicare Secondary Payer laws to protect Medicare’s interest when resolving cases that include future medical expenses. The sum of the set aside is determined on a case-by-case basis and should be reviewed by CMS. A set-aside may be submitted to CMS for review in the following cases:

A claimant is already a Medicare beneficiary and the total settlement amount is greater than $25,000.00
The claimant has a reasonable expectation of Medicare enrollment within 30 months of the settlement date and the anticipated Settlement amount for future medical expense and disability / lost wages over the life duration of the settlement agreement is expected to be greater than $250,000.00.
There are serious ramifications for non-compliance with Medicare Set-Aside rules.

Services:

Formulation of Medicare Set-Aside Plan
Review of Medical Records including Billing Records
Verification of Eligibility for Social Security and/or Medicare Benefits
Rated Age Analysis
Research of applicable Standards of Care and Clinical Practice Guidelines
Formulation Life Care Plan
Evaluation of Settlement of Case
Projection Expected Cost of care
Projection of expected amount of dollars to be set aside for Medicare

Tools and Skills:

Experienced and certified team of professionals
Life Care planning capability
Efficient Methodology
Experienced and Efficient Review Team
High Knowledge in Medical Care Financial Projection
Knowledge of CMS rules and regulations