Do you strive for a 99% first-time pass rate with CMS?
No. Due to our aggressive approach to allocating, we do not think a high success rate on first-pass approvals is consistent with accomplishing good results for our clients. Our clients frequently ask us to push the envelope with Medicare and to submit the lowest defensible allocation amount. It is our philosophy that a higher approval percentage would probably mean that we are overallocating, which costs our clients money.
In what states do you do Medicare Set-Asides?
We perform workers’ compensation Medicare Set-Aside (MSA) services in every state in the United States that settles medical benefits. We administer MSAs for liability claims in all states requested.
Do you offer field/claims office training?
Yes. We believe that proper Medicare Compliance education is fundamental. As such, we offer free training throughout the United States. To schedule training, contact Michelle Allan at firstname.lastname@example.org
Do all Burns White clients handle Medicare Compliance similarly?
Medicare Compliance is not always a one-size, fits-all deal. While some Medicare rules and regulations are black and white, there is also some gray which leaves much room for interpretation. Our clients espouse differing philosophies about claims handling, Medicare Compliance and risk tolerance, in general. While we do offer a standard program for Medicare Compliance, we can tailor a more specific program for your organization that reflects your core approach to claims. We currently provide special programs for more than fifty percent (50%) of our client base.
How can you assist in developing a Compliance policy?
As a full service Medicare Compliance provider, we can assist in a myriad of ways. Our team of experienced Medicare attorneys are adept at reviewing and auditing existing programs, as well as developing new ones. We can aid in the creation of a comprehensive program addressing Medicare Set-Asides, Medical Cost Projections, Medicare Conditional Payment Resolution and Medicare Mandatory Reporting, or we can focus specifically on one or more of those areas. As your partner, you can trust us to make sure your Medicare Compliance program is up to date with current Medicare laws, regulations and trends. Further, we can ensure that your program is being properly adhered to by Burns White staff through our internal operations training and implementation program.
What kind of Compliance services can be tailored?
The list is endless. And even if we’ve never done it before, we would be willing to discuss it. To give you some ideas, we tailor programs to accommodate our client’s thoughts on how and when to Verify eligibility, when to use an MSA or other allocating method, how often the Burns White team should follow-up with CMS or the MSPRC, when and how we update your claims handlers, and how to incorporate case-specific settlement language.
Do you provide more in-depth services beyond allocating and lien resolution?
Yes. We provide many services that are outside of the usual MSA box. For instance, we can assist during mediations and settlement conferences. We can provide appellate litigation services on Medicare conditional payment disputes, as well as workers’ compensation legal service. As a legal-based provider, we can offer you more.
Do you provide professional administration services?
No. We provide recommendations, advice and price quotes regarding custodial accounts, as well as assisting parties in coordinating with a professional administrator. However, we do not offer professional administration services or special needs trusts.
It is our opinion that for an MSA provider to perform custodial administration is a conflict of interests. Professional administrators are paid based on the amount of the MSA. This would give the MSA provider an incentive to overinflate the MSA amount for their own financial gain. As such, we do not provide these services in-house. We understand custodial administration, and we would be happy to help coordinate these services.
It seems that Medicare rules are always changing. How do you keep up?
As legal professionals, we have an ethical duty to maintain a keen knowledge of our subject material, and thus, we are always aware of current Medicare requirements. We are also constantly monitoring new case law, proposed legislation, and trends with governmental contractors, as well as staying abreast of the industry by active involvement in a number of key organizations.
To add to our knowledge and awareness, we attend, exhibit and speak at numerous conferences. Burns White exhibits at and/or sponsors on average 25-30 conferences throughout the country per year, including but not limited to, large industry events such as the National RIMS conference and the National Workers' Compensation and Disability Conference & Exposition. We have been exhibiting at conferences throughout the country since 2004. Click here to see our list of 2012 conferences.
Memberships in numerous industry organizations also keep us informed. Burns White is a member of dozens of claims associations, chambers of commerce, self-insured associations and bar associations throughout the country. Among the most significant are the following:
Medicare Advocacy Recovery Coalition (MARC), a political group supporting the currently proposed SMART legislation calling for Medicare reform.
The National Association of Medicare Set-Aside Professionals (NAMSAP). Burns White Attorney Benjamin Basista serves as a Board member for NAMSAP. In this role, Mr. Basista is engaged with insurance carriers, self-insured entities and MSA professionals across the country.
Council on Litigation Management (CLM)
Defense Research Institute (DRI)
American Bar Association (ABA)
To keep you updated on the industry, Burns White professionals are available to present specific seminars or updates on a variety of Medicare topics in any location in the United States. We also offer Continuing Education and Continuing Legal Education credits for our presentations. Our presentations can be customized to meet our client's needs in terms of length, content and frequency.
We also provide immediate email bulletins alerting our clients to current events and changes within Medicare. We distribute a monthly newsletter which provides important updates and more detailed information. Bulletins and newsletters, as well as other firm and industry news, also appear on our webpage and blog.
Are you able to customize reports specific to the clients’ request?
Yes. We have the ability to create customized reports to include any pertinent information you deem beneficial. We can discuss with you further your report needs to make certain that our periodic summary would reflect the information most important to you.
Will you provide rated age information?
Yes. Burns White can either provide rated ages through a structured settlement broker recommended by your organization or through one of the many structured settlement brokers we partner with.
Do you outsource any of the analysis needed in connection with an MSA to an outside source?
No. Burns White has never referred a case to another vendor for MSA review or preparation. All MSA preparation and submission is handled in-house by Burns White attorneys and professionals. The Medicare Group also does not have a contract for service, policies or procedures that binds the Medicare Group or its professionals to deal with a subcontractor.
How long has your organization been completing MSA allocations?
The Burns White Medicare Compliance Group has been doing MSA work for more than twelve (12) years. Burns White began preparing MSAs on a national basis in 2000. Our Medicare practice was a natural expansion of our workers’ compensation defense practice.
What is the average completion time?
Ten (10) business days or less.
Do you have an option to RUSH an MSA allocation?
Yes. A referral made as a rush request can be completed within three (3) business days or less. We also have a rush service for 24-hour-or-less needs. The cover letter for the Medicare Set-Aside will provide a status report indicating how the matter should proceed.
Do you offer guarantees that the allocation worked up will be accepted by CMS?
Please note we do not offer a guarantee program for the following reasons:
It is our opinion that the allocator offering a guarantee program has a financial interest in the outcome of the MSA, which we believe could be a violation of ethics.
A guarantee program affords the allocator an incentive to artificially inflate the allocation number which could lead to making the settlement of the claim impossible. Also, this has the potential to place both the carrier and policyholder in an unfair position having to reserve and fund more money to the MSA than was actually necessary.
A guarantee program can be construed as being self-serving for the allocator in an effort to maintain an overall 100% approval rate. Also, the advocacy role of the allocator is taken away when a guarantee program comes into play because of the potential direct financial liability of the MSA allocator (as an example, we would fight to not include a questionable surgery, whereas, a vendor offering a guarantee program would simply add this surgery due to their financial stake in the outcome of the MSA; which leads us back to point number 1).