EBMSAs and How to Protect Yourself and Your Clients

In last week’s blog, we discussed Evidence-Based Medicare Set-Asides (EBMSAs) and why they are risky and problematic. Defense-oriented MSA organizations are selling EBMSAs as a security, but if there is going to be future care that is Medicare’s responsibility, what happens when there is no money to pay it?

 

The answer? You are trading the Work Comp. Carrier for the MSA Carrier. The injured worker may not be able to dictate his or her own treatment.

 

The Centers for Medicare & Medicaid Services (CMS) will come crashing down on defense-oriented EBMSA vendors and the secondary insurance markets will come calling. Executives of these organizations will have made their money and the MSA vendor could go out of business. Medicare will deny payments because an MSA should have covered certain treatment. Plaintiffs and claimants will be left with nothing to pay for their case-related Medicare treatment.

 

So How Do You Protect Yourself and Your Clients?

 

CMS-approved MSAs protect the injured worker for life. Professional administration companies can safely and correctly administer the MSAs so that the funds are extended as long as possible, while your injured workers treat for what they need (not what the average person needs), get better, and move on with their lives.

 

We recommend plaintiff attorneys obtain these CMS-approved MSAs which account for more possibilities in the injured worker’s treatment. Unlike EBMSAs, these MSAs are based on at least the previous two years of treatment for the specific, individual injured worker. These MSAs account for the prescriptions and treatments that have worked for the injured worker, rather than something else that might not be proper because it is for the average person, rather than your client.

 

The recent trend against CMS-approval is based in an attempt to further cut benefits to the plaintiffs. For example, we believe certain vendors’ Non-Submit MSAs cost carriers upwards of $17,000, whereas most MSAs are billed at $2,500-$3,500. Carriers are willing to pay $17,000 for a NSMSA because the MSA allocation is tens of thousands of dollars less than what CMS would require.

 

Remember that an “Evidence-Based” MSA is not based on your case’s evidence whereas CMS-approved MSAs are based on your case’s evidence and your clients’ conditions.

 

MASSIVE is the partner you can trust to answer your questions on EBMSAs and handle all your Lien Resolution and Future Medical Allocations (including MSAs). Contact our experienced and dedicated team today to learn how our services can work to get a bigger recovery for both you and your clients.