Medicare Set Aside Claims Settlement – Why All Cost Containment Processes are Not Created Equal

There are countless reasons why settlements are unable to be completed, or exceed the existing reserve, but many boil down to an excessive MSA.

The financial repercussions of MSAs on large loss claims can be significant, typically fueled by a high pharmacy regimen and medications that are no longer being actively prescribed. While the medical cost containment strategies of others fall short, large loss cases referred to ANS typically show an average reduction in pharmaceutical costs of up to 25%. Our success is attributed to our proprietary Pharmacotherapy Review Program focused around a “face-to-face” collaborative approach between our highly credentialed nurse experts and treating physicians to facilitate modifications in the drug treatment regimen.

Medicare Set Aside - ANS medical cost containment help bring all the pieces together

When you have the right tools all the pieces fall into place…

Reducing Medicare Set Aside & Part D Exposure Through Pharmacotherapy Review

When it comes to reducing Medicare Set Aside and mitigating Part D Exposure, obtaining optimal results not only requires the right tools but a pro-active approach early on in the process. For the past decade ANS Solutions has honed and perfected an evolved drug utilization review program. Our  proprietary Pharmacotherapy Review Program was developed specifically to give Payers the tools and resources needed to address high MSA costs- the result is a three stage approach:

  1. PharmReview – during this stage, the injured worker’s existing pharmaceutical regimen is assessed by nurse experts and modification recommendations are determined.
  2. PharmIntervention – a face-to-face discussion with the treating physician to achieve consensus on a modified medication regimen and commitment on a future course of treatment.
  3. PharmCompliance- an ANS Clinical Liaison Officer ensures compliance with the new prescription treatment plan. This provides a proactive management of the case to optimize hard cost savings.

Our highly credentialed legal nurse experts provide actionable recommendations based on the individual patient and engage effectively with treating physicians. This innovative program is the only true “face-to-face” approach to reducing costs in large loss workers’ compensation cases in the industry. Because Pharmacotherapy Review involves an open, collaborative dialogue with the physician, adjustments to a pharmaceutical program can be made in an expedient and collegial manner.  The face to face interaction between our Certified Legal Nurses and prescribing physicians yields:

  • a clear medical action plan that drives down costs
  • maximum buy-in to a program of cost containment
  • improved outcomes for claimants
  • reasonable claim settlements

ANS’ Pharmacotherapy Review Program dramatically improves success by eliminating the miscommunication and misunderstanding that cause a carrier to miss-out on a prospective settlement.