MSP Compliance

MSP Compliance Services – Our Comprehensive Solution

ICS provides clients with access to a comprehensive solution of MSP compliance services for the Workers’ Compensation, Auto, and Liability markets.

We provide clients with an integrated MSP Compliance Service Program focused on reducing claim cost, positioning a claim for settlement, and promoting compliance. Our staff is comprised of subject matter experts who demonstrate and are capable of defending the adequate consideration of Medicare’s future interest for all types of claims

MSP Compliance Services –

Medicare Set Aside

An advocacy-driven approach to compliance

Our staff is comprised of subject matter experts who demonstrate and are capable of defending the consideration of Medicare’s interest for all types of claims.

Background and Goals of the Medicare Set Aside

As the name suggests, a Medicare Set-Aside (MSA) is a finite sum that is set aside by the primary payer, typically in a claim settlement, based on an estimate of future health care costs for a Medicare beneficiary due to a work-related or general liability injury, illness or disease. Medicare has recommended MSA’s as a reasonable means of protecting Medicare’s interests for future medical expenses

  • ICS’ Medicare Set-Aside Program includes a variety of services that help you comply with the Medicare requirements and drive the most importing goal —-settlement of the claim.
  • Our Medicare Set Aside’s create a measure of guidance on settlement language, strategy, and justification of the MSA amount.
  • Allocation figures are produced by our team of in-house compliance experts using our proprietary technology to accurately forecast future medical and pharmacy costs.

MSP Compliance Services –

CMS Legal Submission

An advocacy-driven approach to compliance

Our expertise allows you to submit the MSA to CMS for review and approval, while solidly protecting Medicare’s interests.

We update claimant’s eligibility status for Social Security and Medicare benefits and advise on method of funding, administering MSA, and Settlement Allocation language.

MSP Compliance Services –

Medicare Conditional Payment Management

An advocacy-driven approach to compliance

Pay what you owe and nothing more – Challenging Medicare’s Demand for Reimbursement.

Background and Goals of the Conditional Payment Process

The Commercial Repayment Center (CRC) will now pursue recovery on claims where the insurer is the debtor: typically No-Fault and Workers’ Compensation claims.  Based on its audits of reported claims, the CRC will issue a Conditional Payment Notice (CPN) on every workers’ compensation or no-fault claim reported under Section 111 when they have determined Medicare has paid bills related to that claim

You have only 30 days to dispute the charges. If no dispute is submitted in the 30 day timeframe, the CPN automatically converts to a Final Demand Letter (FDL) and interest will start to accrue. This requires you to dispute the CPN within a month. If you do not respond within the 30 days, you will possess a FDL.

The Conditional Payment Notice outlines all charges Medicare has paid and expects to be reimbursed. In other words, Medicare will send a bill for every single claim where they should be the secondary payer. You can never assume that all the charges on a CPN are related to the injuries sustained.

ICS has been reviewing and successfully disputing Conditional Payment Notices (CPN) for several years. We have a proven process that works with Medicare

Many vendors can’t or won’t aggressively challenge Medicare’s demands for reimbursement of conditional payments.  But the ICS Conditional Payment Service gives you a team with the experience to identify issues that can and will reduce Medicare’s demands

  • Our nurse auditor experts review every CPN demand within 30 days of receipt and identify charges that are not related to the claim that guarantees our clients reimburse Medicare the correct and accurate amount.
  • In the case of No-Fault and Workers Compensation claims, we will address all CPN’s and FDL’s within Medicare’s strict guidelines to alleviate overpayment or penalties and interest.

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Questions?

To learn more about our services, please call (732)-384-3430