top of page

Frequently Asked Questions

What does PlanPoint specialize in?

PlanPoint specializes in all aspects of Medicare Secondary Payer (MSP) Act Compliance and projection of future medical costs. For the better part of two decades, PlanPoint has offered comprehensive services to that end which promote settlement and mitigate risk. We execute the Medicare Set Aside (MSA), the Life Care Plan (LCP), the Medical Cost Projection (MCP), and Conditional Payment Lien (CPL) investigation/dispute services.

What is the Medicare Secondary Payer Act?

At a very high level, the Medicare Secondary Payer (MSP) Act is a U.S. federal law designed to ensure that Medicare remains the ‘secondary payer’ and does not bear responsibility for healthcare expenses when other insurance or responsible parties (‘primary payers’) should cover those costs. The Act plays a crucial role in safeguarding the Medicare program’s financial health by assuring it is not burdened with costs for healthcare that should be covered by other insurance or responsible parties. The MSP Act specifically establishes a framework for identifying situations where another entity, such as a private insurer, self-insured entity, or responsible party, should cover medical expenses before Medicare. There are rules and requirements for the complete spectrum of an injury claim -- from start to finish -- for certain Medicare-eligible individuals with other insurance coverage, such as group health plans, workers' compensation, or liability insurance, and failure to comply with the MSP Act can result in penalties, fines, and legal consequences.

What is a Medicare Set Aside (MSA)?

An MSA is a financial arrangement that allocates a portion of a settlement to cover future medical expenses for a person who is Medicare-eligible due to age or disability as outlined by the Centers for Medicare and Medicaid Services (CMS). The MSA is authored by certfied professionals to prevent Medicare from paying for medical costs that would otherwise be the responsibility of the carrier.

Why is a Life Care Plan (LCP) important?

A Life Care Plan is a comprehensive document outlining the long-term medical and non-medical needs of an individual who has suffered a catastrophic injury. It assists in assessing the cost of future care, therapy, and related services, which is vital for settlement negotiations.

What is a Medical Cost Projection (MCP), and how does it differ from an MSA?

An MCP is an estimate of the future medical expenses required by an injured party, even if they are not Medicare-eligible. It assists in determining the total cost of care needed post-injury. In contrast, an MSA is specifically for individuals who are Medicare-eligible and focuses on ensuring Medicare's interests are protected. There are highly specific differences in the MCP (and LCP) versus the MSA that prevent two from being interchangeable. The key distinction lies in the fact that the MSA safeguards Medicare's interests, whereas the MCP/LCP outlines the future medical needs of the injured party.

How is an MCP different from an LCP?

The MCP is a highly objective report accounting for future medical value in an injury claim. Thiis document accounts for medical history and physician opinion when formulating a projection of medically necessary goods and services attributable to the claim of injury. The LCP requires a complete review of medical records much in the same way of a Medical Cost Projection, however the LCP allows for the author to assert their professional opinion based on the facts of medical review with regard to future, medically necessary goods and services. Opinions and conclusions are based on the subject matter expert's extensive education, highly specific credentials, and vast experience. The Life Care Plan is traditionally reserved for the most catastrophic of injury claims.

What are Conditional Payments?

In certain cases where an injured party is Medicare Eligible, Medicare may elect to make payment for services when payment is not expected to be made in a reasonable timeframe. Although Medicare will make these payments, these payments must be reimbursed, hence being termed 'conditional'.

Why use a service for Conditional Payments?  Can't I do that myself?

You can absolutely acquire all types of case-specific information without the services of a provider like PlanPoint! We encourage it and we are happy to show you how! Conversely, clients often choose to trust PlanPoint to execute these tasks for any number of reasons. The rationale most often stated for deeming PlanPoint as the representative to acquire and dispute any discrepancies are inexperience and time management. At PlanPoint, we can allow you and your staff to focus on work, life, and your work life balance. Rest assured that we can execute for you accurately and in a timely fashion, should you have a need.

Why dispute Conditional Payments?

Just as Medicare aims to avoid being responsible for costs that should be covered by the carrier, settlement parties should not be burdened with expenses unrelated to the case. PlanPoint effectively resolved a dispute involving a millions dollars in a single Conditional Payment Lien!

How can your services help with settlement negotiations?

We support all settlement parties by offering precise, distinctive, and strongly defensible assessments of the potential future medical cost implications associated with the proposed settlement. By offering high quality reporting, our clients can leverage their position and reach compromise more effectively.

Who benefits from utilizing your services?

Our services benefit plaintiffs, defendants, insurance companies, attorneys, and Medicare beneficiaries involved in personal injury or workers' compensation cases, as well as any other parties responsible for managing a portion of the settlement process.

What information is required to provide these services?

Generally, we require relevant medical records and case details. The scope of review of medical history varies from service to service. For MSP-related services, we will require demographics and information on Medicare eligibility status.

Do you provide legal advice or representation?

PlanPoint does not provide legal advice or representation. We work in conjunction with legal teams to provide essential projections for settlement negotiations.

Are your services available nationwide?

Yes! PlanPoint services are available across the United States.

What is the typical timeline for receiving a Medicare Set Aside, Life Care Plan, or Medical Cost Projection?

Timelines will vary depending on the complexity of the case and the availability of medical records as well as the requested service. While we strive to provide efficient and accurate assessments, timelines most certainly differ from case to case. In a rush? We will work with you to meet your timelines.

Why is this all so complicated?

Don't fret! This is all part of the process. All of these services are necessary to accurately depict the value of future medical, whether it be for Medicare or the injured party. PlanPoint excels in this process. Allow us to do what we do best, so that you can do the same. Reach out and we can go to work for you!

How do you ensure the accuracy and reliability of your assessments?

Our team consists of experienced professionals, including Certified Life Care Planners, Nurses, and Subject Matter Experts who conduct thorough assessments based on the most up-to-date medical guidelines and standards of care. We prioritize accuracy and transparency in our reporting and education for our clients. We welcome questions. An educated client is our favorite type of client!

Why choose PlanPoint?

PlanPoint is a family-owned and operated business providing Subject Matter Expert services built on trust, transparency, and education. Our clients consistently turn to us because we streamline the process, making it straightforward and hassle-free. What's more? The founder of PlanPoint is the author of the definitive credential for executing Medicare Secondary Payer Act Compliance. In the realm of Medicare Secondary Payer Act compliance, which encompasses MSAs, MSA Submission, Conditional Lien Analysis Investigation/Dispute, and Medicare Set-Aside allocations -- we're the experts – quite literally!

How can I reach you for more details?

We are honored that you consider and trust PlanPoint with your case. You can visit our Contact page, or simply click the link below to email us!

bottom of page