Success Spotlight: MSA Reduced by Over $600K Through Re-Review Process

At IMPAXX we advocate for our customers, which sometimes includes setting the record straight when the Centers for Medicare & Medicaid Services (CMS) includes treatments or medications in a Workers’ Compensation Medicare Set-Aside (WCMSA) that are not warranted and are inconsistent with the documentation provided as part of submission.

Recently, our advocacy was needed when we submitted a WCMSA to CMS and they included a medication that increased the allocation by over $621,000. Since we are proactive when we submit to CMS, and anticipate potential issues, we work with our customer to prepare the most accurate allocation possible with supporting documentation. In this case, we had all the necessary documentation, all of which predated the submission, to demonstrate that the drug was not being utilized. As a result, through the Re-Review process, we were able to argue for the removal of the medication with CMS issuing a new allocation minus the $621,000.

This case illustrates the difference working with an MSA partner who can anticipate issues and aggressively pursue solutions (before and after the WCMSA submission process) can make. IMPAXX has over 20 years of experience submitting MSAs to CMS and obtaining optimal outcomes for our customers. We track multiple years’ worth of data along with current trends from CMS’ review contractor and use it to our customers’ advantage. At IMPAXX, we are committed to achieving the best outcomes possible.

To learn more about our WCMSA programs or any of our innovative Medicare compliance solutions, please contact the IMPAXX Settlement Consulting team at [email protected].