Atlanta Legal Nurse Consultant 770-725-2997
| Liz Buddenhagen, RN Atlanta Legal Nurse Consultant |
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Medicare Set-Aside
Taking Medicare’s interest into consideration is imperative when settling
Workers Compensation and liability cases in regard to future medical care of
individuals meeting certain criteria. If this interest is not sufficiently addressed, Medicare
can resort to legal action, monetary penalties and can possibly jeopardize future
Medicare benefits of your client.
The Medicare Secondary Payer Act of 1980 was designed to prohibit Medicare from
paying for medical treatment that was also covered by other insurers. The SCHIP
Extension Act of 2007 requires all primary payers to determine if a claimant is entitled to
Medicare and report to Medicare if appropriate.
A Medicare Set-Aside is the vehicle by which money is set aside to help cover the
future medicare costs.
Buddenhagen & Associates assists attorneys by identifying impacted claimants,
preparing a detailed report (allocation) based on medical records and cost estimates of
future medical care for Medicare approval when indicated, and submitting the MSA to
Center for Medicare & Medicaid Services (CMS). Hence, funds may be “set aside” to
provide for future medical care with regard to Medicare acceptability.
Our Professional Registered Nurses analyze medical records, create medical cost
projections and formulate the proper paperwork to meet Medicare requirements and to
provide framework to keep you from settling inadequately when considering
Medicare’s interests.
Medical Cost Projection or Future Medical Assessment
A Medical Cost Projection provides a cost estimate of future medical care, durable
medical equipment (DME) and prescription drugs. Medical complications can be
included. Records are organized, reviewed and costs analyzed in a brief summary with
timeline from date of injury forward.
A Medical Cost Projection (MCP) is designed for those claims where an Medicare Set-
Aside (MSA)/Life Care Plan (LCP) is not yet appropriate, such as setting reserves and
settlement/mediation negotiations. A Medical Cost Projection is a “mini” Life Care
Plan, so to speak.
The Medical Cost Projection is based on the medical reports from all treating providers.
A medical summary of initial injury, current treatment, future medical needs, and any
pre-existing and/or co-existing conditions is included. Costs are itemized on an annual
and lifetime basis.
For Workers’ Compensation cases, WC Fee Schedule, private pay or usual and
customary cost can be used at discretion of the attorney.
A Medical Cost Projection is not recommended for litigated cases which will result
in a jury trial.
A Medical Cost Projection adds to the attorney toolbox of cost containment by
having a Buddenhagen & Associates professional Registered Nurse analyze your case
in a quick and efficient manner regarding cost analysis.
Call us today for a free consultation: 770-725-2997
________________
"Buddenhagen &
Associates is an
integral part of my
practice and has
dramatically improved
my efficiency over the
years. I love that I am
able to let them do
what they do best,
which is simplify the
complex medical issues
and the
documentation. They
make the medicine
easy to understand
and they organize the
documents so they are
easy to work with, both
of which save me
hours of time that I can
use to focus on the
legal issues of my
cases."
Audrey Tolson, Esq.
The Tolson Firm, LLC
Atlanta, Georgia
________________
"Buddenhagen &
Associates is an
integral part of my
practice and has
dramatically improved
my efficiency over the
years. I love that I am
able to let them do
what they do best,
which is simplify the
complex medical issues
and the
documentation. They
make the medicine
easy to understand
and they organize the
documents so they are
easy to work with, both
of which save me
hours of time that I can
use to focus on the
legal issues of my
cases."
Audrey Tolson, Esq.
The Tolson Firm, LLC
Atlanta, Georgia
________________