Medicare Set-Aside (MSA) Decision Engine

Call 855-MSA-3279 for a demo | Evaluate, Allocate, SubmitBuilding on a decade of experience providing MSA services, GRG launches an innovative online-based tool, the MSA Decision Engine. It simplifies the first step that evaluates whether an MSA is needed by guiding you through a series of simple questions and steps and provides a comprehensive, accurate, fast and compliant recommendation to ensure Medicare’s future interests are appropriately considered.

 

Pre-Screen Checklist

Prior to launching the MSA Decision Engine, each case undergoes a simple pre-screening to prevent you from performing an evaluation on a case that does not meet the basic criteria whereby a MSA could be recommended. If it is determined that your case is not a candidate for a MSA, the checklist will generate documentation for your file to support that conclusion. Where a MSA could be required, you will be prompted to begin entering your case information into the Decision Engine.

Evaluation

The Decision Engine takes a formalized approach to each case. The user is asked a series of questions to develop four profiles:

  • Claimant profile
  • Claim/injury profile
  • Healthcare profile
  • Litigation profile

Decision

Upon completion of the profiles, the Decision Engine utilizes the case-specific data you entered to calculate a decision. You are provided with a straightforward report that states whether or not a MSA is recommended. The complete report can be downloaded as a pdf to document your file and memorialize the fact that Medicare’s future interest has been considered and protected. In addition to the recommendation, the report includes exhibits that detail the data you entered, sample release language to be used by the parties, and a MSA Disclosure Form to be reviewed and executed by the claimant.

Next Steps

If the recommendation is that a MSA is not required, you will have documentation for your file to support that conclusion. If the recommendation is that a MSA is required you will be provided with action steps to ensure proper Medicare compliance.

Backing

The MSA Decision Engine is based on all relevant statutory, regulatory and administrative guidance from CMS as well as relevant case law. Federal law provides that Medicare is intended to be the payer of last resort when a primary payer or plan has accepted responsibility for medical expenses and then provides compensation for those medical expenses. This is true for past medicals (date of injury to date of resolution) as well as future medicals (date of resolution going forward).