Medicare and MSA Services

A Workers’ Compensation carrier/provider has always been a primary payer to Medicare. The primary purpose of the passage of the Medicare Secondary Payer Act (MSP) was to make Medicare a secondary payer to other insurance, in addition to Workers’ Compensation. The MSP specifically indicates that Medicare’s interest must be taken into consideration with regard to any Workers’ Compensation settlement that forecloses future medical benefits. The essence of the MSP is to prevent the shifting of responsibility for payment of work related medical services and prescription drug charges from a Workers’ Compensation provider who is a primary player to Medicare.

Since its introduction to New York State in 2001, our firm has been at the forefront of the introduction of the MSP to Workers’ Compensation settlements in the State of New York. Our firm established a Medicare/MSA Department of knowledgeable Workers’ Compensation examiners with more than 25 years of experience, and certified registered nurses. Our firm offers our clients an overall approach that includes the expertise of a Workers’ Compensation attorney, an experienced Workers’ Compensation examiner, and a certified registered nursing staff in the preparation of every MSA allocation. We handle the MSA from the initial negotiation and preparation of the settlement through the preparation of the MSA, and submission to CMS in those cases where CMS review is recommended. In those cases where CMS review is not recommended, we offer our clients services with regard to the preparation of a Claims Settlement Allocation (CSA) to be included in the settlement agreement protecting Medicare’s interest.

Our firm offers the following services provided by our Medicare/MSA Department:

  • Preparation of MSA in accordance with CMS Guidelines;
  • Conditional payment/lien reduction services;
  • Legal opinion letters;
  • MSA’s with structured settlements;
  • Social Security and Medicare verification;
  • Rated age;
  • Preparation of Appeals/Requests for Reconsideration of CMS/MSA determinations.

We pride ourselves in the ability to provide our clients with a Settlement Department which incorporates the negotiation and preparation of settlement agreements, inclusive of the handling of any and all Medicare issues as required by the MSP.

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