Given CMS’ recent modification of their review process for zero-dollar MSAs in denied claims, parties with pending CMS proposals should be aware of their options. If the submission does not have a treating physician’s opinion that no further injury-alleged care is required, the parties may consider the use of a compromise allocation as a way of giving Medicare’s interests reasonable consideration in the denied claim. The compromise allocation sets a portion of the net settlement aside for Medicare’s interests. The amount of the allocation is based on the relative value of the future medical treatment when compared to the total potential trial exposure. This approach prevents a cost shift of injury-related expenses to Medicare in the denied claim. If this approach is selected, we recommend that the pending CMS proposal be immediately withdrawn.
Other options include allowing CMS to issue their determination or the parties may wish to consider a certified non-submitted MSA .
Please contact NuQuest’s settlement consultants for additional details regarding the available alternate options.