At VP-Medical our Medical-Legal Nurse Consultants are professional, highly-skilled, registered nurses who bring their training forward to work directly with attorneys on medical related expenses.

Our professionals provide an accurate projection of the anticipated Medicare and non-Medicare covered services related to your client’s future medical costs through the individual’s life expectancy. This cost may be associated with Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA), a Liability Insurance Medicare Set-Aside Arrangement (LMSA), or a No-Fault Insurance Medicare Set-Aside Arrangement (NFMSA).

Cost projections include a detailed description of each allocated service by Medicare, including Part D prescription and Off-Label Drug review while thoroughly determining the amount of money to “set aside” from the settlement proceeds for future medical costs.

Medicare Set-Aside Allocation Services:

Projections of Medicare allowable injury related expenses, including Part D prescription

Social Security and Medicare status determination

Reporting to COBC to initiate a Medicare conditional payment claim investigation

Determination of rated age life expectancy (additional cost)

Medicare Conditional Payment Claim Investigation

Conditional payment research

Medicare Conditional Payment Claim Negotiation

Recommendations regarding the appropriateness of Medicare’s claim


The Liability MSA: (LMSA)

Submission of MSA allocation and supporting documents to CMS for reviewOngoing communication with CMS throughout the review processReconsideration to CMS, if applicable.

Preparation of the submission document and supporting attachments requesting approval of a $0 MSA allocation in disputed/denied casesSocial Security and Medicare status determinationMedicare conditional payment claim investigationOngoing communication with CMS throughout the review process.

medical case management
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Let our professionals assist you with your Medicare Set-Aside Allocations.

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