Many inflated Medicare Set-Aside (MSA) recommendations are due simply to poor timing. Most claims that settle involve peaks and valleys in medical treatment.

Those peaks are typically found near surgeries. Typically, you do not want to get an MSA analysis within 90 days of a surgery. An MSA analysis done in that proximity to surgery is far more likely to warrant inclusion of prescription medication that will not be needed on a long-term basis.

Another trend I have noticed is the fact that medical needs tend to spike near litigation events like mediations and trials. If you get an MSA analysis at that time you may get an inflated MSA recommendation due to this phenomenon. And with a trial date pending you may not have the time to obtain medical evidence that would provide an acceptable MSA recommendation. Once you realize settlement of the claim is a possibility try and determine if an MSA analysis is warranted as soon as possible.

An MSA analysis is a snapshot of the claim. Pick your snapshots wisely. In most cases MMI (maximum medical improvement) assignment and a stable medication regimen is when you want to move forward with an MSA assignment. And if you get an acceptable MSA recommendation and the anticipated settlement amount is going to exceed CMS review thresholds then you may want to go ahead and ask your MSA professional to submit the case to CMS before an actual settlement agreement has been reached. That is a proactive approach to try and avoid the pitfalls above that might derail the MSA and settlement later. Open and unsettled claims rarely get better with age.

MAPS Medical is happy to look over the medical records on your case and let you know if it is a suitable time to proceed with an MSA analysis and CMS submission. And if the time is right MAPS Medical will handle those tasks promptly and professionally to allow you to get that claim settled and closed as soon as possible.