Today’s Topic: Piggyback MSAs
Today’s sixty-second blog can easily save a company a few hundred thousand dollars in just one workers’ compensation claim. You won’t believe how simple it is. We call it settling a claim with a Piggyback MSA.
Before explaining the process, please allow us to first ask two simple questions:
- Have you ever seen a situation where an injured worker has numerous past workers’ compensation claims on file? Of course you have. Some applicants have been known to file a work comp claim against every employer they ever worked for, with several active cases still pending at the Board.
- Have you ever noticed a Medicare Set Aside (MSA) allocation exceeding $250,000? It is quite common. We have actually seen several allocations exceed $1 million.
With that said, if you examine the open inventory of claims on file at your office you will probably find several cases where the injured worker resolved a prior claim against a former employer where the settlement required an MSA. Let’s presume an employee settled a former claim involving a low back injury, just like the one you are currently handling. Upon settlement of that former claim, the employer funded an MSA allocation identifying the necessity of five future low back spinal cord stimulator implants, having a combined value of $525,000. However, in order to settle your claim, another MSA is now necessary. Of course, your first step is to develop an allocation. This is where we can save you a great deal of money. We recommend you compare your allocation to the one previously approved by CMS. Of course, that means you need to do your homework to obtain a copy of that prior allocation. By chance, if the applicant somehow lost the previously approved MSA paperwork, chances are a copy will still exist in the Board’s file. Once both allocations are available your goal is to search for duplicative future medical services. For example, suppose both allocations identify a need for 5 future low back spinal cord stimulator implants. Since these services were already funded in the previous MSA, there is no need for you to fund them again. Simply piggyback on the prior MSA. You just saved yourself $525,000. It’s as easy as that. In fact, you can piggyback on all duplicative medical services currently funded under the claimant’s prior MSA. Just take your time and explain everything in detail to CMS when seeking approval of your piggyback allocation. All parties, including CMS, should agree there is no legitimate reason for identical future medical procedures to be funded twice under two separate MSAs.