Our Services

By providing first-in-class consultative services, we remain focused on serving our clients when they need unmatched Medicare Secondary Payer (MSP) expertise.

Medicare Set-Aside Services:

  • A Medicare Set Aside which accurately reflects the amount of Medicare-covered, workers’ compensation claim-related future medical care for an individual claimant.

    *This report is intended for CMS submission

  • An evidenced-based set-aside that accurately reflects the amount of Medicare-covered, workers’ compensation claim-related future medical care for an individual claimant. This report is not intended for CMS submission; indemnification is offered.

    *Indemnification not offered for fully denied claims or zero-dollar MSA requests

  • A set-aside that accurately reflects the amount of Medicare-covered, liability claim-related future medical care for an individual claimant.

    *This report is not intended for submission

  • An evidenced-based set-aside that accurately reflects the amount of Medicare-covered, liability claim-related future medical care for an individual claimant.

    *This report is not intended for submission; indemnification is offered

  • A set-aside for claims where liability/compensability is not accepted (i.e., fully denied workers’ compensation claims or contested liability claims) which defensibly allocates a small portion of the settlement for future medical care (adjusted based upon factors unique to the settlement).

    *This report is not intended for CMS submission; indemnification is offered

  • A future cost report which accurately projects the future amount of Medicare-covered and non-Medicare-covered treatment for an individual claimant.

    *This report is not intended for submission

  • A future medical care report which identifies key costs drivers and makes recommendations for achieving CMS-approved MSA reductions

  • Communicate with treating physician(s) to obtain signed statements regarding the last date of treatment, treatment recommendations, and possible treatment changes to try to mitigate key cost drivers.

  • An evidenced-based Medicare Set-Aside which accurately reflects the amount of Medicare-covered, workers’ compensation claim-related future medical care for an individual claimant. This report is intended for CMS submission; therefore, indemnification is not included as standard.

    *If, however, a tentative settlement occurs with the parties agreeing to waive submission of the eMSA to CMS, Sanderson Firm may, at its sole discretion, agree to provide indemnification of the allocation provided that Sanderson Firm reviews and approves the final proposed settlement documents prior to final Commission approval. If the eMSA is indemnified, the iMSA service pricing will apply.

Social Security Disability (SSDI) Enrollment:

  • Determines an individual’s Social Security enrollment status from the Social Security office

Medicare Conditional Payment Services:

  • Secure conditional payment information from Medicare to include the status of the debt and current conditional payment amount owed.

  • Evaluate conditional payment charges and determine whether the alleged charges are related to the claim

  • File disputes and appeals with Medicare’s first-level contractors regarding alleged conditional payment debts

  • Receive the updated conditional payment amount prior to finalizing the resolution of the claim

  • Secure Medicare’s Final Demand Letter / Case Closure Letter regarding the conditional payment debt

  • Correspond with Medicare contractors to resolve beneficiary’s Medicare benefit issues.

  • File disputes and appeals with Medicare’s second-level contractors regarding alleged conditional payment debts

  • File a Request for ALJ Hearing with Medicare’s third level of appeals, and present oral arguments before the assigned ALJ regarding alleged conditional payment debts

  • Resolve Medicare Advantage Plan (Medicare Part C), Prescription Drug Plan (Medicare Part D), Medicaid Liens and Healthcare Liens (ERISA, Tricare, etc.)

MMSEA Section 111 Reporting Services:

  • Report claims as required under Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA)

  • Assist clients in understanding their Section 111 reporting obligations; identify existing and potential reporting errors within our clients’ current data sets, and provide targeted solutions for compliance.

Other MSP Legal Services:

  • Provide legal counsel regarding all aspects of MSP compliance – Section 111 reporting, conditional payment recoveries, and future medical obligations.

  • Provide counsel, proposed edits, and proposed addenda for workers’ compensation and liability settlements involving Medicare Secondary Payer exposure

  • Identify appropriate Responsible Reporting Entities (RREs) for purposes of Section 111 compliance, and determine correct settlement data to report to Medicare.

  • Prepare a Legal Opinion Letter which provides legal analysis and recommendation for your Medicare Secondary Payer concern

  • Assess your organization’s current MSP compliance practices, and provide custom recommendations for improving compliance.

  • Insurance carriers and self-insurers must report bodily injury claims to Medicare and reimburse conditional payments made on behalf of claimants under MMSEA. Our SSN/DOB Research Service quickly delivers missing information, helping you comply with MMSEA requirements and streamline the claim process.

  • Provide litigation support, expert consulting, and testifying expert witness services as requested. This includes but is not limited to, review of documents and data, litigation support consulting, report writing and delivery, and expert testimony.