Achieve full compliance for future medical allocations while managing expenses
Complying with Medicare’s demands for future medical allocations requires deep knowledge of both medical and legal aspects of injury claims. ISO Claims Partners has a range of services to help you comply and expertly manage expenses.
Determine accurate Workers’ Comp Medicare Set-Asides (WCMSAs)
When it comes to determining a workers’ compensation claimant’s future medical costs, accuracy is key to successful CMS compliance. Insurers also need to protect their interests by ensuring that CMS demands align with injuries related to the claim. ISO Claims Partners offers a wide range of allocation services to help achieve both compliance goals.
Clients saved 7.2 million Medicare Set-Aside rebuttals and re-reviews in 2019.
Medicare Set-Aside (MSA)
Medicare Set-Aside (MSA)ISO Claims Partners has the largest team of medical and legal experts dedicated to CMS compliance and accurate development of Medicare Set-Asides (MSAs). Our team partners with insurers to reduce costs and optimize claim settlement.
Medical Cost Projection (MCP)
Medical Cost Projection (MCP)Our team of nurse practitioners analyzes medical records to develop future medical costs for claims. Insurers receive an assessment of medical exposure to determine if settlement is possible.
MSA cost reductions from ISO Claims Partners:
- $1.4 million saved – We demanded CMS re-review of a WCMSA by successfully arguing that CMS failed to appropriately acknowledge a court decision that excluded a major condition as nonindustrial.
- $580,000 saved – We recommended an Amended Review (through CMS’s new Amended Review process) that led to a dosage adjustment.
- $345,000 saved – We collaborated with the physician and adjuster to determine the spinal cord stimulator and associated medications were no longer recommended, resulting in future medicals reduction.
Pre-MSA
Pre-MSAWorkers’ comp insurers can receive a snapshot of potential MSA cost drivers, providing them with the opportunity to intervene before the full spend of the MSA.
MSA Second Look
MSA Second LookOur consultative approach allows workers’ comp insurers to make the most of CMS Amended Review opportunities. MSA Second Look client savings totaled $6.7 million from 2017 to 2018.
CMS approval rate for Legal Zero allocations is 93 percent.
Non-Submit/WC Limited Allocation
Non-Submit/WC Limited AllocationWhen an MSA or CMS submission is not appropriate on a claim, insurers still need to consider Medicare’s interests. In these cases, ISO Claims Partners calculates claimants’ future medical allocations.
Legal Zero Allocation
Legal Zero AllocationIf a claim is fully denied and no future dollars need to be set aside, our legal team will prepare case-specific arguments and stand ready to defend them to CMS.
Settlement Services
ISO Claims Partners’ team of medical and legal experts can remove obstacles to closing complex claims. We’ll help identify a book of claims to tackle, coordinate settlement conferences, and expedite preparation of MSAs or conditional payments. You’ll achieve large-scale claims resolution from a concentrated, time-efficient effort.
Learn more about ISO Claims Partners solutions
Section 111 Reporting
Accurate Medicare reporting lets insurers comply with ease
Lien Services
Mitigate compliance costs of Medicare and Medicaid liens
Workers’ Compensation Claims Management
Manage complex claims and reporting requirements
Medicare Compliance and Reporting
A range of efficient and accurate Medicare compliance services