Legal Zero

Disputed claims and Zero MSAs—advocacy matters

ISO Claims Partners Legal Zero is a set of services that can help you reduce the cost of individual Medicare Set-Asides (MSAs) to $0 in appropriate cases.

Background

To get the most favorable agreement with Medicare on an MSA, you need to consider both medical and legal issues involved in the underlying claim. Why should you allocate money for future medical treatment when you aren’t the primary payer? Why increase the cost of a settlement when you’re dealing with a denied or disputed claim? Why abandon state law defenses just because the case involves Medicare?

Many insurers and other payers don’t use such defenses. While that may be the easy path for an MSA vendor, it’s not in your best interest. In fact, it can be a very costly mistake.

When you engage ISO Claims Partners, we look for opportunities to argue that an allocation of $0 for future medical expenses is appropriate. That’s a Legal Zero.

A Legal Zero saves you money, and it sends the message to Medicare that state law continues to apply to claims and settlements.

Key features of Legal Zero

The services that make up Legal Zero include:

  • legal and medical advocacy
  • case-specific arguments
  • case evaluation, issue spotting, and identifying key arguments
  • appeal to the next level (if and when necessary)

Benefits of Legal Zero

  • lower costs
  • fewer unnecessary trials
  • experienced legal and medical advocacy

Case example

An insurer hired another vendor to prepare an MSA. The vendor calculated a value of $33,379. CMS issued a counterdemand for $163,241. The insurer then engaged ISO Claims Partners to reexamine the case. ISO Claims Partners advanced a legal argument that, under state law, the insurer was not responsible for certain aspects of the claim. The Centers for Medicare and Medicaid Services (CMS) approved an MSA of $0. Savings from Legal Zero: $163,241.

For more information about ISO Claims Partners Medicare compliance services

Representatives are available Monday through Friday, 9 a.m. through 8:30 p.m. Eastern time.