Case Management Solutions is a dedicated partner that can forensically identify, intervene and address the obstacles that can stall MSAs and get customers to settlement. Case Management Solutions offers full MSP compliance services that leverage Medical, Legal and Pharmacy industry experts to provide a solution that protects Medicare’s interest and gain claims resolution.
A Physician Follow up and signed attestation was received from and the following medications have been discontinued and no longer part of the treatment plan; Hydrocodone/APAP 10-325mg, Meloxicam 15mg, Omeprazole 20mg, Zolpidem 5mg, Alprazolam 1mg and Ondansetron 4mg. Initial MSA was $318,932.00 and was revised after receiving documentation in response to physician outreach, which resulted in removing the medications in question, deleting labs and lowering physician visits is $45,793.00.
RESULT: This is a SAVINGS of $273,138.00!
We received confirmation from Dr. S that Ibuprofen can be dispensed over the counter! The MSA has been updated to reflect this change; your MSA has decreased from $13,957 to $8,643.
RESULT: That is a SAVINGS of $5,314!
After review of the arbitration order, CMS determined that it was appropriate to remove Gralise from the WCMSA allocation, which accounted for $297,227.00 of the previously received counter higher. Furthermore, CMS reduced the medications Bupropion and Venlafaxine to two years. A reduction of occupational medicine and psychiatrist visits to quarterly for 2 years were also noted, which reduced the allocation from $445,583.00 to $59,151.00.
RESULTS: This is a SAVINGS of $386,432.00!
We received the signed letter from Dr. S confirming the discontinuation of all the medications. Since the medications were discontinued, we were able to remove the lab work and reduce the physician visits.
RESULTS: Updated MSA shows a total SAVINGS of $198,328.81!
Tetrabenazine was not included in MSA because it is off-label. It is covered for chorea related to Huntington’s disease. If the file is submitted to CMS, it is possible they could include it, if they do we will challenge.
RESULTS: Claim EXPOSURE would be $1,353,266.00.
Zero MSA approval on denied claims are still attainable
CMS accepted the most recently provided financial detail and denial along with signed payouts attesting the complete representation of all payments made on the claim as sufficient evidence to finally compete their review. Therefore, we have received the long awaited ZERO CMS Approval for claimant S. Adjuster, we appreciate your assistance with providing the extra documentation for the difficult situation with CMS!
Received CMS approval letter for claimant and accepted the attestation from Dr. M confirming that the medication Vimovo has been discontinued. CMS approved MSA in full with no counter offer ($71,200.00).
RESULT: Eliminated $211,970.00 exposure.
We have revised the MSA report in the matter of claimant to include the 1/18/2017 letter of Dr. T which was obtained to confirm there is no injury-related ongoing Cymbalta use on this claim. Please note that with the MSA amount remains $101,156 as it was assumed in the original MSA report that there was no ongoing Cymbalta use.
Challenging a Medicare Lien with the right partner can produce big results.
RESULTS: Savings of $96,489.38
Nurse identified an opportunity to switch brand name medication to generic and change second medication to more cost effective alternative. Letter was prepared, sent and physician was in agreement (no additional cost for this service).
RESULTS: Physician Outreach yielded a savings of $200,352.00.