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Professional Administration

Professional Administration

We have entered an era where The Centers for Medicare and Medicaid Services (CMS) has unprecedented access to settlement data involving Medicare beneficiaries. It is now more important than ever to ensure Medicare’s future interests are protected in your settlements.  Medicare Set-Aside professional administration is a proven tool to assure the settling parties remain in compliance with Medicare Secondary Payer (MSP) obligations.

Medivest is the leading Medicare Set-Aside (MSA) professional administration provider in the industry.  We were the first to professionally administer a Medicare Set-Aside Arrangement, and have been providing this service to the workers’ compensation and liability industry for over 20 years, longer than anyone else. Our services guarantee the most comprehensive and cost-effective professional administration program available. You can be confident that you’re working with the most experienced and trained MSA professionals in the field. The result is unparalleled competency, capability, and service.

We were the first to professionally administer a Medicare Set-Aside Arrangement, and have been providing this service for over 20 years, longer than anyone else in the industry.

Unparalleled Fiduciary Expertise

Correspondence with Medicare

Including the requisite reporting, coordination of primary payer benefits during periods of temporary or permanent exhaustion, to protect those Medicare benefits.

Coordination of Health Benefits

We work with the injured person’s other health insurance benefits, including Medicare, Medicaid and private group health insurance policies.

Claims Adjudication & Payment

We provide prompt and accurate processing and payment of medical claims in accordance with Medicare Secondary Payer compliance rules and regs.

Claim Reduction Negotiation

We actively negotiate with medical providers and facilities on medical bills in excess of $5,000 to reduce expenditures and stretch custodial funds.

Negotiated Prescription Drug Pricing

We leverage our buying power as a professional administrator to attain significant discounts of prescription drugs for our members, resulting in considerable savings.

DME & Medical Supply Discounts

Our network of durable medical equipment (DME) and medical supply vendors give Medivest members discounts on items like catheters and wheelchairs.

Tax Consideration Assistance

We will coordinate with the our members and their tax accountants to make sure they properly report any impact their custodial accounts have on their IRS filings.

Estate Planning Assistance

We assist our members, their beneficiaries and executor with the estate planning and preparation of fiduciary account funds at end of life.

Medivest’s professional administration goes well beyond the paying of medical claims. Our experience enables us to offer an array of services others don’t, and that means better service for the injured person.

The Complex Made Simple for the Injured Person

Medivest makes utilizing the custodial account easy.
1. The injured person shows their Medivest Member ID Card to their doctor when they seek treatment, or to their pharmacist when they fill their prescriptions.
2. Their doctor or pharmacist will contact Medivest to verify benefits, just as they would with any other major medical insurance provider.
3. The injured party’s billing notices are then sent directly to Medivest for processing.
professional administration Member ID card

No co-pays, deductibles or out-of-pocket expense when you visit your doctor or fill a prescription.

Our MSA Accounts Save Big on Prescription Drugs

Medivest negotiates aggressive prescription drug pricing for the Medicare Set-Asides we administer.  For an injured person with a chronic injury requiring ongoing drug treatment, this can add up to thousands of dollars in savings a year.  A self-administering injured person with no prescription benefit will struggle to get these kinds of savings (or no savings at all) at the pharmacy counter.  Medivest not only makes sure the prices paid for prescriptions don’t exceed the requisite Redbook AWP rate, we go further to maximize every penny of the MSA.

This example shows the savings on a typical 30 days supply of prescription medications (based on 2015 retail pharmacy data and actual script fills).

Drug (30-Day Supply) Retail Redbook AWP Medivest Rate
Topiramate TAB 100MG $226.55 $181.24 $29.85
Montelukast TAB 10MG $212.13 $169.70 $38.74
Baclofen TAB 10MG $254.51 $203.61 $44.29
Bupropn HCL TAB 300MG $178.80 $143.04 $52.22
Voltaren Gel 1% $68.04 $54.43 $53.34
Relpax TAB 40MG $974.03 $779.22 $735.71
Advair AER 250/50 $446.88 $357.50 $348.57
Suboxone MIS 8-2MG $633.45 $506.76 $485.59
TOTAL: $2,994.38 $2,395.50 $1,788.31

And, by utilizing our mail order pharmacy service, the injured person can receive a 90-day supply of prescriptions at an even greater savings.

As Comprehensive as You Need It

You may not be aware that Medivest can administer more than just the Medicare allowable portion of a settlement. In addition to the Medicare set-aside, the non-Medicare allowable funds can also be professionally administered, and this can represent a huge benefit an convenience to the injured person.

Medicare Set-Aside Account

Medicare Set-Aside Professional Administration strictly pertains to the management of the Medicare Set-Aside funds only. This service involves adjudication and approval of only Medicare allowable expenses related to the injury. All expenses are paid at the appropriate fee schedule. This is the most comprehensive Medicare Secondary Payer compliance measure available today.

Medical Custodial Account

Medical Custodial Professional Administration pertains to the management of a medical custodial account that typically consists of any non-Medicare allowable medical expenses. This service involves adjudication and approval of expenses as dictated by the settlement. MCAs can be used to address a wide variety of issues, from paying only non-Medicare allowable medical expenses, to paying copays on insurance premiums, Medicare copays if the MSA temporarily or permanently exhausts, and even other expenses such as living expenses.

Periodic distributions can also be made to the injured person, as dictated by the settlement. The flexibility of the MCA makes it a useful tool that protects settlement funds from dissipation risk, and offers the settling parties assurance that these funds will be used in accordance with the intent of the settlement.

Advantages to Having Both Accounts Administered Together

  • Flexible arrangements can be made that  can take special circumstances into consideration without jeopardizing MSP compliance.
  • Both the Medicare allowable and non-Medicare allowable portions of the claim can be paid, instead of the injured person being responsible for either portion themselves.
  • Coordination with CMS during MSA exhaustions to pay Medicare copays, resulting in no out-of-pocket medical expenses for the injured person.
  • Deep discounts on annual fees when both accounts are administered by Medivest as a bundle.

Integrating Medivest Medicare Set-Aside Professional Administration Services Into Your Settlement

We’ve helped settling parties engineer win-win solutions in every state in this nation.  From simple straightforward claims, to the most complex, we’ve developed resolutions that address an array of post-settlement concerns.  Medivest’s settlement consultants provide the necessary agreements, settlement language, and guidance to considerably simplify the integration of medicare set-aside professional administration into a settlement.  Services such as file review, mediation consultation, on-site training, and waiver language are provided free of charge, regardless of whether medicare set-aside professional administration is utilized.  We’re committed to facilitating solutions.

Ready to take the ultimate step toward MSP compliance?

Contact Medivest today at 1-877-725-2467 or email us at info@medivest.com.