Legal Services Department: MSP Issues and MSA Arrangements

The Medicare Set-Aside Arrangements (MSA) Program, resulting from the Medicare Policy Memo (Patel Memo) of 2001, and outlining the procedures and requirements for successful MSA submission, continues to be developed and modified. For example, a significant procedural change became effective on May 1, 2004; all Workers' Compensation Medicare Set-aside Arrangement (WCMSA) proposals submitted for review by CMS' Regional Offices are being sent to a national, centralized office, the Coordination of Benefits Center (COBC). Once recorded, they are assigned to a COB Contractor, and the WCMSA proposal is then electronically forwarded to the Regional Office (RO) having jurisdiction for review and consideration for approval.

The Centers for Medicare and Medicaid Services (CMS) have indicated that approximately 80% of all submissions to the COBC are initially rejected, typically for not providing adequate information to be processed by CMS for approval of WCMSA settlements. Contrary to these statistics, Gould & Lamb receives approval on over 98% of its submissions on the first attempt and 100% approval overall.

Unquestionably, Gould & Lamb has become a leading authority in the MSA arena and is recognized as a credible and reputable source by the insurance industry and Medicare. As a highly regarded MSA allocation company, we have been a resource for carriers and law firms across the country. In response to our clients' needs, we are expanding our current services and have established our Legal Research Department to provide assistance and research as may be requested by attorneys on specific MSP issues. This department will be able to assist in the preparation of successful MSA arrangements and will also critique proposed MSA arrangements prior to CMS submission to substantially increase the chances of a first time approval. In addition, as a more complete service, we will prepare the actual CMS submission at the attorneys' request and for their review.

In summary, we are offering four different levels for these new services:

1. Research: Gould & Lamb will continue the highest level of quality customer service, providing, at no cost, responses to any routine questions propounded by our clients; however, there often arises a need for a more in depth review of the inquiry, research and written response or memo to counsel. Gould & Lamb's Legal Services Consultants are well equipped to handle these questions regarding Federal MSP compliance. Since time will vary greatly depending upon the complexity of the issue, we will advise of the anticipated research expense for your consideration before proceeding.
   
   
2. Critique: We will review the proposed state settlement document and provide you with a letter with suggested changes and/or redraft the settlement document, with your consent, to ensure compliance with Federal MSP regulations and the current WCMSA settlement review process as mandated by CMS. This review will substantially improve the likelihood of CMS approval on the first attempt, as evidenced by our exemplary first attempt success rate set forth herein. This will be a flat fee service.
   
   

3. Addendum: We will prepare a separate agreement, known as a Medicare Set-Aside Agreement, to address Federal MSP compliance issues apart from the existing state settlement agreement. This document will outline funding parameters, administration method, and current WCMSA settlement review procedures. This service is widely utilized in states with settlement forms that do not typically address the complexities of MSP compliance.

4. Comprehensive Preparation: We will prepare a complete CMS submission package, compiling the necessary documentation from, or based upon, the information provided by your office and pursuant to your instructions. This service includes a review of the state settlement documents and a Memo advising of suggested changes, as well as the addendum service noted above. All documents for submission will be subject to your review and approval, and modifications will be made pursuant to your request or instructions. This service will also be on a flat fee, regardless of the complexity of the settlement or the severity of applicant's injury.
   

Gould & Lamb is committed to providing our customers with all information needed to fulfill their obligations under the Medicare Secondary Payer (MSP) laws. Attorneys play a vital role in building and maintaining the integrity of the Medicare payment system, including its policies, regulations, procedures and requirements. Through our Legal Services Department, we hope to facilitate your compliance with MSP laws and processes as well as provide the support and assistance necessary to increase your chances of receiving a first attempt approval, reduce the possibility of omissions or errors in this continuously evolving area, and eliminate the substantial expenses incurred by your clients resulting from the delays of an initial rejection.