Medical Settlement Specialists (MSS) provides strategic Future Medical Settlement Valuations (FMSV) that differ from Life Care Plans and Medicare Set-Asides. We work on cases of all sizes regardless of Medicare involvement. An FMSV is designed to give you “the big picture” of overall future medical exposure. We will help you to PREPARE the medical portion of your client’s claim, PROTECT your case position and PROVIDE a well-reasoned and supportable future settlement package.
Step-by-Step Process Getting MSS Working For YOU:
- Identify what cases to evaluate/prepare for settlement.
- Use our client portal at www.medicalsettlementspecialists.com/lets-get-started to complete a quick case referral sheet and upload applicable items as outlined below.
- If you prefer to send paper files or make other arrangements for getting MSS your information, please contact us directly at email@example.com.
When to Refer a case to Medical Settlement Specialists (MSS), regardless of case size:
- Anytime you wish to posture the case for settlement or understand future medical exposure
- When the Applicant reaches MMI (NOTE: It can be beneficial to do a workup prior to MMI under certain circumstances and MSS can assist with this)
- When an MSA proposal or demand carrier offer has been provided to your office
- Cases where the carrier will not submit the MSA for approval
- Cases on which you wish to identify and value the non-Medicare items
- Cases where the Applicant will never qualify for Medicare
- Contested claims for which you want to assess potential future medical exposure
- Anytime you wish to assess the medical strengths and weaknesses of your claim
- Anytime you wish to evaluate ways to use the medical evidence to optimize other aspects of the claim (e.g. impairment rating, loss of earning capacity, etc.)
What Items Are Needed for MSS to Provide a Future Medical Settlement Valuation?
- Comprehensive FMSV: Cases where you want a comprehensive understanding of the medical issues/exposure, where Medicare’s interests need to be actively considered, when an MSA/carrier offer has been provided and/or when the carrier will not be submitting the MSA to CMS for approval:
- Carrier MSA/offer if applicableMinimum past 2 years of records claim-related medical records including (past 3 years is ideal)Most recent IME/AME/QME that are applicable to issues ripe for settlementMost current 2 years of carrier medical payment logsMost current 2 years of pharmacy recordsMedication and Supply Form for all current claim related items regardless of who is paying for the item or medication (available when you upload your case via our online portal)
- Information regarding any denied or contested claims that you wish considered for settlement.
- Please advise of any pending litigation deadlines
- Limited Analysis: For cases that require limited analysis (e.g. you are relying on just a few reports to support your settlement goals, there are no uncontested issues, you agree with future care recommendations or are otherwise comfortable with providing limited info), we simply need the limited information on which you are relying and a note advising the file can be done with limited analysis. Limited Analysis reviews still require the Medication and Supply form
Can I just use the Medicare Set Aside (MSA) proposal to evaluate future medical exposure?
- NO! Relying solely on a vender MSA proposal is not recommended
- Many MSAs are not submitted or Medicare may never apply; this can greatly affect how future medical care is identified and valued
- An MSA proposal is designed to protect Medicare’s interests. It is not intended to consider all benefits to which an Applicant may be entitled
- Items not covered by Medicare will not be included in the MSA proposal
- Assessing the value of future medical care outside Medicare guidelines can be advantageous
What does a FMSV include that an MSA does not?
- A FMSV is designed to identify and value all future medical exposure allocations, regardless of Medicare coverage; It provides an understanding of the “big picture”
- A FMSV will identify medical case strengths and weaknesses prior to settlement negotiations
- A FMSV will provide the parties with options for obtaining reasonable settlements and managing client expectations
- Not all cases will require an MSA, but all cases, regardless of size, can benefit from a FMSV
What are the benefits of using Medical Settlement Specialists (MSS)?
- We are workers’ compensation specialists with over 35 years combined experience in determining and valuing future medical care
- Personal service, case-specific analysis
- Our staff is comprised of Certified Workers’ Compensation Professionals, Medicare Set Aside Certified Consultants, Certified Medicare Secondary Payor Professionals, Certified Medical Reimbursement Specialists, Medical and Legal experts, Certified Life Care Planners and Medical Cost Projection Specialists
- Our staff is experienced in navigating complicated fee schedules, medical reimbursement, Medicare Guidelines, and state mandated rules of procedure and treatment guidelines
- Medical Settlement Specialists uses a number of professional and proprietary databases to determine the cost of medical care
- Ensuring accuracy of the Medicare Set-Aside proposal can avoid “counter-higher” delays from CMS
- Understanding total future medical exposure allows the parties to assess their risk allowing for settlement
What value do I receive by using MSS?
- Understand future medical exposure, including that which may be disputed or need further workup
- Identify Medicare and non-Medicare covered medical expenses and provide proper allocations
- Document that the interests of your client and Medicare have been considered on cases where an MSA will not be submitted
- Ability to offer medical evidence to support your position, based on state and Medicare guidelines
- Enhance your understanding of the medical strengths and weaknesses of your case
- Assist you in understanding the difference between the Applicant/Defense cost projections
- Peace of mind – our services provide information that contributes to your ability to know the medical facts of your case, educate your clients accordingly, and document the responsibility and care exercised in assessing the medical value of the claim
What are the risks of performing my own FMSV?
- Consumer internet sites have several pitfalls leading to many inaccuracies
- Fee schedules and medical billing procedures are complicated and easily misinterpreted
- Valuing future medical care by performing a calculation based on the past 2 years of medical costs does not accurately address the type of treatment needed nor the cost of future medical care
- Without understanding medical issues, fee schedules and treatment guides, even limited supportive care or maintenance benefit settlements can be inaccurate
- Doctors are often unaware of the cost of ancillary items related to the care they recommend and may provide you with inaccurate information for settlement purposes
What other services does MSS offer?
- Strategic Future Medical Valuations on cases of all sizes for use during case planning and settlement negotiations regardless of Medicare involvement
- Quick return, limited item cost projections for those cases not requiring a full FMSV
- Life Care Plans for catastrophic cases
- Assistance with settlement proceedings and negotiation strategies
- Support during settlement proceedings/mediation
- Bulk settlement capability (multiple cases with same carrier/defense – “Settlement Days”)
- Alliances with other consultants to offer a wide range of settlement options for structuring and custodial account management