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Think Outside the Box with Us!

We love working with clients on creative solutions to help resolve difficult claims. While we always recommend protecting Medicare’s interests in appropriate cases, we do not always recommend submitting to CMS, even when approval is available. We want you to know there are other options. The solution for every claim does not have to fit inside a box tied with a CMS approval bow.

If you have any type of experience with CMS’s requirements for MSAs or the CMS WCMSA review process, you understand how the process could prevent a quick and/or reasonable resolution of a claim. It can be burdensome and costly to provide the necessary documents when a claimant has stopped treating or treatment has been denied. Presenting denied conditions can be challenging and there is a penalty for mistakenly paying for a denied or unrelated condition. The CMS guidelines for calculating treatment can be quite rigid, such as MRIs every 7 years and x-rays every 3 years for orthopedic injuries.

Making the decision to settle without CMS approval is not without risk, however. You are forgoing the protection provided by obtaining CMS approval in exchange for a faster and less costly settlement. The savings associated with this approach can be significant, and it is certainly worth considering. It is possible to protect Medicare’s interests without obtaining CMS approval. We can provide you with options and advise you of the risks and benefits of each one.

If you are interested in discussing “outside the box” options for resolving your claims, please reach out to us any time. We would be more than happy to assist.


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