Workers’ Compensation Medicare Setaside (WCMSA) Request
The workers’ compensation (WCMSA) analysis will project anticipated work related injury or illness medical services and prescription drug costs which would otherwise be payable or reimbursable by traditional Part A and B Medicare and Part D Medicare. The medical services costs are either promulgated based upon the applicable State fee schedule or full actual charges without consideration of any Medicare deductibles, co-pays or coinsurance. The Centers for Medicare & Medicaid Services (CMS) has established specific guidelines for the calculation of future prescription drug costs currently based upon the average wholesale price as published by Red Book®. Further, these costs are calculated on an annual basis and then projected based upon the client’s life expectancy either based upon the client’s actual chronological age or calculated rated age.
Medical services and prescription drug costs are projected based upon those physician, hospital or prescription drug records provided my office including physician’s estimates of future medical services and/or prescription drug therapy needs, an analysis of the past pattern of utilization of medical services and prescription drug usage, workers’ compensation carrier medical/pharmaceutical payment recap history, previous out of pocket medical/pharmaceutical expenses, the current medical/pharmaceutical treatment regimen, the client’s past responses and outcome to the medical treatment provided, as well as, prescription drug utilization as indicated in the medical record. Present day medical services/prescription drug costs will be utilized and no provision is made for future inflation as CMS does not require inflationary pressures to be factored into the WCMSA analysis. The recommended WCMSA amount is therefore a reflection of those costs that should be “set-aside” from the gross settlement proceeds and designated for medical services and prescription drug costs otherwise payable or reimbursable by Medicare.
Work related non-Medicare covered medical services or prescription drug costs, as well as, annual Medicare deductibles, co-pays and coinsurance which should be factored into any final gross settlement amount. It is recommended that a separate medical allocation be provided for since these medical services and prescription drug costs are NOT part of the WCMSA analysis.
While it is not possible to accurately predict all future medical and technological advances for medical services or prescription drug therapy or associated complications pertaining to this analysis, the WCMSA analysis is thought to reflect what can be reasonably anticipated for future work related medical services and prescription drug therapy based on the information provided.
The WCMSA will normally be completed within 10 business days of receipt of all required information. Send completed materials to: Angelo Paul Sevarino, Esq., 26 Barber Hill Road, Broad Brook, CT 06016.
WCMSA Fee: $1,450.00
Fees are the responsibility of the attorney or law firm requesting the WCMSA analysis and are not contingent upon any contractual relationship between the attorney/law firm and client or upon the ultimate settlement or judgment. All fees are due and payable net 10 days. Interest of 1.5% per month is charged for all outstanding invoices.
- The following required information is necessary for completion of a WCMSA analysis and may be mailed to 26 Barber Hill Road, Broad Brook, CT 06016:
- Completion of “Specific Case Information” sheet
- Complete set of medical reports for the last two years of treatment. Include all surgical reports and hospital discharge records from date of injury forward.
- Pharmacy printout or statement from treating physician(s) for all prescribed drugs for the last two (2) years of treatment. Include name of drug, unit form (capsule, tablet, patch etc.), prescribed strength, dosage and prescribed frequency. THIS MUST BE A CURRENT VERSION OF THE PRINTOUT NO OLDER THAN 6 MONTHS FROM THE DATE SUBMITTED.
- Medical payment recap history from the workers’ compensation carrier covering the last two years of treatment from the workers’ compensation carrier or administrator. THIS MUST BE A CURRENT VERSION OF THE RECAP HISTORY PRINTED NO OLDER THAN 6 MONTHS FROM THE DATE SUBMITTED.
- If an implantable device is being used or recommended you should consult with the appropriate physician and provide the following information:
- Device, electrodes, receiver manufacturer name
- Device, electrodes, receiver model # or type
- Device, electrodes, receiver cost including tax, freight and handling
- Facility fee, whether inpatient or outpatient, procedure code and cost
- Surgeon procedure code and cost
- Anesthesiologist procedure code and cost
- Programming services procedure code, frequency and cost
- Other associated costs
- Copy of Medicare, Medigap and Prescription Part D cards as applicable
- Signed Authorizations
- The submitting attorney/law firm warrants to Angelo Paul Sevarino, Esq. that s/he has explained to their client that (a) no attorney-client relationship is being established between their client and Angelo Paul Sevarino, Esq., and (b) their client consents to Angelo Paul Sevarino, Esq. reviewing the submitted documents and communicating with the Social Security Administration or The Centers for Medicare & Medicaid Services as may be required. Further, the attorney/law firm warrants to Angelo Paul Sevarino, Esq. the accuracy of all the information contained herein.