MEDICARE COMPLIANCE SERVICES
At Synergy, we’re not just a service provider—we’re your strategic partner in Medicare compliance, seamlessly integrating with your firm to boost efficiency from day one. We take on Medicare compliance issues while your firm focuses on securing justice for more clients. Working with Synergy’s Medicare compliance experts leads to better resolution outcomes and improved client experiences. Equally as important, our team frees your staff from Medicare compliance tasks leading to greater utilization rates for the firm’s attorneys as well as paralegals. That translates into more revenue for your law practice.
Synergy’s MSP360° suite of services gives you access to a team of experts who can evaluate your client’s case, advise you about the difficult and ever-changing terrain of the MSP landscape, and be your guide to total Medicare compliance. We provide the following services to attorneys nationwide for workers’ compensation claims, liability claims, medical malpractice, Longshore and Harbor Worker’s Compensation Act (LHWCA) claims, Jones Act claims and FELA railroad claims. Our services will put you into control of the Medicare process instead of leaving it in the hands of the defense so that you can speed up settlements involving Medicare beneficiaries by demonstrating to the other side that compliance issues have been addressed.
If you represent a client who is Medicare eligible, whose care was or may be paid for by Medicare and, may require future accident-related care, you need to consult with the Medicare experts at Synergy. The Medicare Secondary Payer (MSP) Act is complicated with numerous issues that can arise jeopardizing compliance. Having a holistic, accurate assessment of your client’s situation is essential to protecting their future as well as insulating your practice from what could be devastating government-enforced consequences. Synergy’s team of experienced Medicare Secondary Payer compliance professionals guide you through the issues around MSP compliance, giving you confidence that your client’s Medicare eligibility is protected. Our Total Medicare Compliance solution, MSP 360, gives you a suite of services which will put your mind at ease and allow you to do what you do best–win the next case.
Our team of Medicare Secondary Payer Compliance experts:
- Consult with you about past payments and with your client regarding Medicare future-interest protection mechanisms, versus the risk of doing nothing.
- Advise your client so they can make an informed decision about what they would like to do; and allow you to
- Document your file accordingly.
We will create a comprehensive plan to allow you to close your file compliantly, by resolving conditional payments and Medicare advantage liens as well as considering Medicare’s potential “future interest” in the settlement. Our customized approach provides case specific options rather than using a cookie cutter approach. By partnering with Synergy for Medicare Compliance, your firm gains a trusted partner to address ever-changing compliance rules. In addition, you will improve client experience and will feel confident knowing your firm is mitigating risk associated with liability that may arise from failure to advise your client regarding MSP compliance–a win-win.
To get started, we suggest you schedule a Medicare Expert Case Evaluation (MECE). This allows you to consult with one of our industry-leading MSP Compliance experts today to see how partnering with Synergy for Medicare Secondary Payer Compliance services ensures the most appropriate MSP solution for your case. Request Expert Evaluation
If you represent a client who is Medicare-eligible and is likely to continue to treat post settlement, we recommend a Medicare Expert Case Evaluation (MECE) when you resolve the case.
MECE is a case specific video conference or telephone consultation to educate the client on Medicare’s potential interest in the settlement. It includes customized options for “future interest” protection mechanisms. Should the client decline to create a recommended Medicare Set-Aside (MSA) after consultation, we will prepare a customized waiver for the client to sign to document that election.
We provide a detailed analysis of the future medical needs for an injured party over life when we create our allocation recommendations. Our litigation nurse consultants and life care planners work to ensure an accurate and justifiable position to present to the Centers for Medicare and Medicaid Services (CMS)when CMS review is available and requested by the parties.
To ensure that Medicare’s interests are properly addressed by the opposing party’s set aside allocation; we can do an independent review of the proposed Medicare Set Aside allocation. Having an independent analysis will help counsel decide whether the proposed set aside by the opposing party is sufficient.
The Medicare Secondary Payer Act is a complex piece of legislation with far reaching impact. We can provide advice on adequately considering Medicare’s interest under the MSP in a liability case and whether or not an MSA should be utilized in order to protect your client and firm.
If a liability Medicare set-aside analysis is performed, Synergy can provide a proprietary reduction analysis that takes into account a limited recovery to reduce the amount of the set-aside.
We can provide a detailed analysis of costs that will not be covered by Medicare. Having this information allows counsel to quantify what the MSA will not cover and present that figure to the defense. This analysis can help increase the value of the claim by quantifying how much care is not covered by the MSA.
As part of our case review service, we can perform a Social Security and Medicare status determination. We can determine whether a case meets CMS / MSA review thresholds. We assist attorneys in preparing all necessary documentation and help with any required language that must be in settlement documents.
We prepare the formal MSA submission package for CMS to assure proper compliance under the Medicare Secondary Payer Statute. We also provide post-MSA submission follow up and communication with CMS, as well as ongoing submission updates to our client. At this time, CMS is only providing review of Workers’ Compensation Medicare Set-Asides that meet CMS’ voluntary review thresholds.
We assist attorneys in preparing all necessary documentation and help with any required language that must be in settlement documents.
Medicare may make a conditional payment when there is evidence that the primary plan does not pay promptly conditioned upon reimbursement when the primary plan does pay. When Medicare does make a conditional payment, Synergy can resolve the claims against the settlement by Medicare including compromise & waiver requests.
Medicare Advantage plans have the same right to recover as traditional Medicare. Medicare Advantage Organizations (MAOs) are handled by private insurance carriers. Synergy can report the liability claim, audit and dispute claims for unrelated care and negotiation of the final amount to be repaid.
We offer free CLE training to help you understand the complexities of the Medicare Secondary Payer Statute. We are your trusted partner in MSP compliance.