Medical Record Review for Medicare Set-Asides
AI-powered Accuracy for Smarter Medicare Set-Aside Allocations
When settlements include future medical expenses, accurate medical record analysis is essential for preparing a Medicare Set-Aside (MSA). Streamline your MSA workflow with our specialized medical record review services, powered by advanced AI technology and backed by over two decades of medico-legal expertise.
We deliver comprehensive medical chart reviews for Medicare Set-Asides, ensuring reliable cost projections and compliant CMS submissions.
Types of Medicare Set-Asides
- Workers’ Compensation MSAs (WCMSAs) address workplace injury settlements. For current Medicare beneficiaries, CMS generally requires review of WCMSA proposals if the total settlement exceeds $25,000.
- Personal Injury MSAs cover liability settlements from auto accidents, medical malpractice, and product liability cases. Unlike WCMSAs, there is no official CMS review process for PIMSAs, but proper allocation is still important to avoid future Medicare denials.
No-Fault MSAs:- Applicable in no-fault auto insurance states where personal injury protection (PIP) benefits are used.
- Cover future medical expenses related to the injury once PIP benefits are exhausted.
- Often follow similar allocation principles as WCMSAs but are specific to no-fault insurance settlements.
Our Comprehensive Role in Medicare Set-Asides
We provide end-to-end MSA support beyond medical record review. Our medical record review services pull critical injury details and treatment histories from within complex documentation. Our allocation expertise translates medical findings into accurate cost projections that satisfy CMS requirements. We follow strict compliance that ensures MSA submissions meet Medicare Secondary Payer regulations, thereby reducing rejection risks and development letters.
Why Medical Record Review Matters in MSA
- Promptly identifies all injury-related medical conditions requiring further treatment
- Ensures comprehensive cost projections for CMS submissions
- Documents treatment history and physician recommendations
- Supports compliance with Medicare Secondary Payer (MSP) regulations
- Mitigates risk of CMS rejection or development letters
CMS Requirements for Medical Documentation
Essential medical records for MSA submissions:
Treatment History
Physician Notes
Diagnostic Reports
Prescription Records
Treatment Plans
Our Medical Record Review Process for Medicare Set-Aside Preparation
We streamline medical record review, thereby enabling MSA allocation teams to focus on compliance, projections, and settlements.
Medical Chart Review
- Review notes, reports, and records
- Identify injury-related treatments accurately
- AI flags overlooked clinical details
Treatment Trend Identification
- Track recurring treatments and therapies
- Predict possible future surgeries required
- Highlight physician recommendations clearly
Prescription History Analysis
- Review current and past medications
- Assess future drug therapy needs
- Cross-check Medicare drug schedules
Summarized Reporting
- Deliver concise structured summaries
- Customize outputs per client needs
- Support MSA allocation team decisions
What We Provide for Your MSA Practice
Detailed Medical Summaries
- Comprehensive injury-related medical history
- Treatment response documentation
- Physician recommendations for future care
- Prescription drug history and projections
Clinical Analysis Reports
- Future medical needs assessment
- Treatment necessity documentation
- Life expectancy considerations
- Medicare coverage eligibility analysis
Supporting Documentation
- Organized medical chronologies
- Treatment gap identification
- Clinical justification summaries
- Physician recommendation extracts
Why Choose MOS for Medical Record Review for MSA?
AI-driven Accuracy
Our proprietary AI technology ensures comprehensive analysis of medical records, identifying subtle patterns and future care indicators that traditional review methods might miss.
MSA-focused Expertise
- 20+ years of medico-legal experience
- Deep understanding of CMS requirements
- Specialized knowledge of Medicare coverage policies
- Experienced in handling complex injury cases
Rapid Turnaround
- Standard reviews: 5-7 business days
- Rush services available for urgent cases
- Dedicated project managers
- Real-time status updates
Cost-effective Solutions
- 30-50% cost savings compared to traditional review methods
- Transparent pricing structure
- Scalable services for high-end practices
- No hidden fees or surprise charges
Quality Assurance
- Multi-level review process
- Medical professional oversight
- HIPAA-compliant procedures
- Accuracy verification protocols
Supporting Your MSA Process
Whether you are an MSA allocator, law firm, insurer, or settlement consultant, our AI-powered medical record analysis helps you prepare for stronger, more compliant MSA submissions.
Partner with the Experts
Ready to streamline your MSA medical record review process?
FAQs
What is a Medicare Set-Aside (MSA)?
A Medicare Set-Aside is a portion of a settlement that takes care of any future medical expenses related to an injury that Medicare would otherwise pay for.
When is medical record review needed for MSA?
Medical record review is crucial to identify all injury-related conditions, ensure accurate cost projections, and prevent CMS rejection.
What records are required for MSA preparation?
Treatment history, physician notes, diagnostic reports, prescription records, and treatment plans from the last two years of treatment.
How long does your review process take?
Standard reviews are generally completed in 5-7 business days, with rush services available for urgent cases.
What makes your AI-powered review different?
Our AI technology identifies subtle patterns and future care indicators that traditional methods might miss, ensuring comprehensive analysis.
What deliverables do you provide for MSA?
Detailed medical summaries, clinical analysis reports, organized chronologies, and physician recommendation extracts tailored for MSA teams.
How much can I save with your MSA record review services?
Our AI-powered review provides 30-50% cost savings compared to traditional review methods with transparent pricing.
How do you ensure compliance with CMS guidelines?
We follow the latest CMS policies and use compliance-driven templates to make sure submissions meet approval requirements.
Can you customize the review based on case complexity?
Absolutely. We tailor our reviews for catastrophic injuries, long-term disabilities, or straightforward claims, ensuring the right level of detail.
Do you review both past and future medical care?
Yes. Our reviews account for past treatments as well as likely future interventions, helping establish a realistic and defensible allocation.
Can attorneys or case managers request specific formats or focus areas?
Yes. We can tailor the summaries, chronologies, and clinical analyses according to your preferences, highlighting areas critical to your case strategy.
What if additional records are received after your review?
We can update and revise our summaries quickly to reflect new records, ensuring the MSA remains accurate and up-to-date.
Do you offer secure handling of sensitive records?
Yes. All medical records are handled with strict HIPAA compliance, secure transfer protocols, and encryption for confidentiality.
Can your summaries be integrated into MSA software or reporting tools?
We provide outputs in flexible formats (Word, PDF, Excel) that can be easily incorporated into your internal systems or MSA preparation tools.