Is a Medicare Set-aside analysis prepared by a commercial vendor absolutely necessary for submission of a Medicare Set-aside to CMS?
A62. No. However, the referral must include an analysis of the future medical services and prescription drug therapy charges exposure and how it was calculated. Utilization of a certified Medicare Set-aside consultant in the preparation of a Medicare Set-aside analysis is probably the most accurate manner to prepare this data for presentation to CMS. A Medicare Set-aside analysis is a document based upon published standards of practice, comprehensive assessment, data analysis and research, which provides an organized, concise analysis of current and future medical service needs and prescription drug therapy charges for the injured party. There are numerous commercial vendors, in-house insurance industry individuals and attorneys who prepare Medicare Set-aside analysis. The quality and costs of these entities varies greatly. Note, that CMS does not necessarily consider the Medicare Set-aside as conclusive. CMS may not credit the analysis if there is information that calls the analysis i
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