MCMC provides the evaluations you need for a Medicare Set-aside. MCMC partners with a nationally recognized legal firm to offer a single expert service resource, taking a realistic and legally sound approach to the Medicare Secondary Payor Statute.
The most critical step in a Medicare Set-aside is developing a thorough monetary settlement amount for future medical needs. MCMC will identify the Medical Allocation Amount with annual and lifetime costs for Medicare related as well as non Medicare related services.
Our Medical Cost Allocation Services include:
- Complete Legal Review: Medicare Settlement Specialists review the legal requirements as outlined by CMS and stand behind that opinion with professional liability coverage.
- Comprehensive Review of Medical Records: MCMC’s Medicare Set Aside Nurse Consultants document the type and frequency of medical services with major emphasis on services “post stabilization” and detailing each service pathway.
- Review of Payment History: MCMC’s Certified Medicare Set Aside Nurse Consultants identify past annual medical costs going back for two or three years.
- Identify Physician Recommendations for Future Care: MCMC’s Certified Medicare Set Aside Nurse Consultants review ongoing care assessments by treating providers, IMEs, and second opinion exams to clarify recommendations for future care.
- Standards of Care Review: MCMC’s Certified Medicare Set Aside Nurse Consultants identify costs for projected Medicare covered items and services.
Life Care Plan
MCMC’s Certified Nurse Life Care Planners offer Life Care Plans and Medical Cost Projections to provide you with critical monetary information for litigation preparation, reserve setting, or projected claim costs. Each report includes a comprehensive narrative detailing the injury/illness, treatment, and projected care. Costs are provided in a series of easily understood tables that include the frequency and cost of each service or item.
This is a concise individualized plan estimating current and future, reasonable and necessary, healthcare services and goods with associated costs. The Life Care Plan is typically used for litigation purposes and is line by line defensible. The Life Care Plan is based on:
- Medical records
- Claimant and family interview
- Medical provider consultation and recommendations
Medical Cost Projection
This consists of a short or long term estimate of reasonable and necessary healthcare services and goods with associated costs. A limited version of the Life Care Plan, this report is based on medical records and evidenced based guidelines. There is no claimant, family or medical provider contact. The Medical Cost Projection is used for:
- Setting reserves
- Estimating cost for medical care
- Projecting costs for specific treatment (Surgery, Spinal Cord Stimulator, Intrathecal pain pump)
- Settlement purposes