Services

Conditional Payment Management

Conditional Payment Management

Franco Signor offers conditional payment management that helps you resolve recovery actions by CMS. We combine advanced data-processing technology with our unparalleled MSP expertise to provide a strategy that satisfies CMS requirements for conditional payment recovery. Let us provide you with easy-to-understand steps that resolve conditional payment matters quickly.

BCRC/CRC Notification/Medicare Verification

Obtaining Medicare beneficiary status and notifying the BCRC of the injury is one of the key steps to initiating MSP Compliance. Franco Signor will contact the BCRC to verify the claim record is on file with Medicare and if not, report the information. We will then follow up to ensure the claim has been added by the BCRC and transition to the MSPRC (Medicare Secondary Payer Recovery Contractor).

Medicare/Social Security Verification

Even if a claim doesn’t involve a Medicare beneficiary, it can be important to know the Social Security status of the claimant. Franco Signor can prepare and file a request with Medicare and the Social Security Administration to determine the injured party’s eligibility status for both benefits programs.

Conditional Payment Resolution

Medicare can pay for medical items and services immediately after a no fault, liability (including self-insurance), or workers’ compensation claim. When that claim is settled (or a judgement, award, or other payment is secured), Medicare is immediately entitled to reimbursement. Medicare calls these owed payments “conditional payments.”

Franco Signor specialized in conditional payment resolution. Resolving conditional payment issues in an MSP case requires specialized skills and a thorough understanding of the claim, state legislation, and federal regulations. Our team of claims, legal and medical experts will work hand-in-hand with you and your counsel to promptly identify these payments made by Medicare, update it if necessary, negotiate and dispute unrelated recovery amounts, and secure the Demand when the time is right with the MSP Recovery Contractor.

Medicare Set-Aside Allocations (MSA)

Workers’ Compensation MSA

Our Workers’ Compensation MSA Allocations (WCMSA Allocations) are built according to CMS guidelines to ensure accuracy. At Franco Signor, we offer industry-leading turnaround times and have the best total dollars submitted to total dollars approved ratio. Plus, we understand the approval process and address issues that might trigger denial—before your WCMSA is submitted.

Evidence Based MSA

Traditional MSA Allocations, which follow recommended CMS regulations, can require unrealistic medical guidelines that cause costs to spiral out of control. Franco Signor’s Evidence Based MSA Allocations (EBMSA) uses nationally recognized clinical guidelines to accurately project future medical care for Medicare-covered expenses.

Our EBMSA are built to satisfy Medicare Secondary Payer Act obligations for both parties. Plus, by eliminating unnecessary Medicare costs on prescription drugs and medical items and services, our EBMSA provides increased settlement opportunities for claims.

Liability MSA

While CMS works on the release of new guidelines for the voluntary review of Liability Medicare Set-Aside Allocations (LMSA), Franco Signor has developed our own service to protect Medicare’s interest after the settlement of a claim. Future guidelines might not release liability for primary plans, which is why we offer maximum protection for all parties involved under current guidelines.

Non-Submit MSA

Not every Medicare Set-Aside should be submitted to CMS. Let Franco Signor’s expert team help you decide if your claim is right for our Non-Submit MSA. This program can increase settlement opportunities and eliminate unnecessary Medicare costs while protecting Medicare’s interests.

Non-Submit MSA Allocations take advantage of nationally accepted clinical guidelines (such as ACOEG and ODG) to project future medical care for Medicare covered expenses.

Future Medical Cost Projection

Let Franco Signor’s expert clinicians help you project future medical costs for your claims. We will identify the primary cost drivers for both medical and pharmacy costs to help reserve or determine lifetime medical exposure on a case. We provide recommendations and management strategies to control claim costs. FMCP services are billed at a flat rate based on the complexity of the claim.

Life Care Planning

Our expert clinical team can prepare a Life Care Plan (LCP) that projects future medical costs for claimants with catastrophic medical conditions. Franco Signor utilizes a certified life planner to address individual issues and variables in order to maximize independence and improve quality of life. Our LCP services are billed on an hourly basis.

Release and/or Settlement Agreement Review

Our team of in-house attorneys will work with your counsel to review settlement and release language to ensure MSP compliance. Each document will be unique and based on the facts of your case instead of boiler plate form language so commonly provided by other vendors. Since the law makes all parties to a claim legally responsible to pay Medicare it is in the best interests of all parties to get this document right from the start.

Mandatory Insurer Reporting

Mandatory Insurer Reporting

Our latest technologies make satisfying CMS requirements for mandatory insurer reporting easier than ever. At Franco Signor, we offer several solutions to report data to regulating bodies as required by the Medicare and Medicaid SCHIP Extension Act of 2007. We build our quotes based on individual needs and look forward to designing a solution for you.

MSP compliance Audit

Franco Signor provides Strategic MSP Compliance Audits for  responsible reporting entities to provide peace of mind and help avoid costly penalties. Our process can identify gaps in your current processes for both data compliance and conditional payment compliance. Talk to Franco Signor today to see if our compliance audit services are right for your company.

MAP/PArt D Lien Resolution

Medicare Advantage Plans (MAPs) and Part D Prescription Drug Plans (PDPs), private insurance companies that offer Medicare coverage to beneficiaries in lieu of traditional Medicare coverage, won the right to recover reimbursements. However, the Commercial Repayment Contractor and the Benefits Coordination & Recovery Center can’t help claimants identify and pay back these private conditional payment obligations.

Franco Signor can identify these private obligations for you. We are the only MSP compliance vendor that can quickly identify the MAPs and PDPs liens associated with your claimant.

PHARMACY MANAGEMENT

Franco Signor provides comprehensive pharmacy management solutions for our clients in partnership with PRIUM. Our expertise in MSP compliance and Mandatory Insurance Reporting combined with PRIUM technology and strong clinically-based pharmacy and case management service support programs for prescription review and peer-to-peer service and medical case oversight.

Professional administration

Professional Administration

Many MSA vendors forget the Medicare Beneficiary in the compliance process. At Franco Signor, we provide compliance solutions for all parties involved—including programs and services to help Medicare beneficiaries manage and maintain allocated funds after claim settlement.

Our CareMDRx service revolutionizes the way Medicare beneficiaries pay for and manage the costs associated with medical and pharmaceutical expenses after an accident. Discover never-before-seen clarity, efficiency, and savings in a traditionally complex and difficult to navigate system.

Assisted Administration

An alternative to our professional administration services, our assisted administration services through CareMDRx is perfect for clients who want to hold funds in their own bank account but want the peace of mind of Franco Signor’s management services. This solution is designed for individuals who are a Medicare beneficiary, reasonably expected to be a Medicare beneficiary in the next 30 months, or not a Medicare beneficiary at all.

MEDICAID Compliance

Franco Signor offers proven strategies to effectively manage third party liability obligations for Medicaid. Medicaid requires reimbursement from beneficiaries that receive a settlement, judgment, or award for their workers’ compensation, no-fault or liability case for related treatment paid for by the state Medicaid program. While defendants aren’t typically responsible for reimbursement to Medicaid plans for liens, there are exceptions that vary by state.

Medi-caL Beneficiary Identification

Identifying claimants enrolled in California’s Medi-Cal program has been historically difficult. Franco Signor has developed a service specifically to provide clients with the most current enrollment information available. It’s never been easier to properly identify Medi-Cal beneficiaries.

Additional Claims Services

Covid-19 Claim Services

COVID Reserve Setting Tool (CREST)

The COVID Reserve Setting Tool (CREST) is one of two lines of service we have developed to help clients during the COVID-19 pandemic. CREST provides clients with a high-level overview of the expected costs related to the diagnosis and treatment of COVID-19.

COVID Medical Cost Projection Service (CMCPS)

Estimating the cost of a COVID-19 claim can be difficult due to the varying degree of severity patients suffer, especially those with co-morbid conditions. Our COVID Medical Cost Projection Service (CMCPS) provides a detailed projection of costs utilizing an evidence-based methodology built on actual billed amounts or applicable fee schedules.

Critical Information Identification Service

Franco Signor’s Critical Information identification Service provides clients with missing information needed to identify claims. We can look up either a claimant’s Date of Birth or Social Security Number within minuteseither individually or in batches of up to 1,000 claims at a time.

Essential MSP Services

Mandatory Insurer Reporting

Mandatory Insurer Reporting

Our latest technologies make satisfying CMS requirements for mandatory insurer reporting easier than ever. At Franco Signor, we offer several solutions to report data to regulating bodies as required by the Medicare and Medicaid SCHIP Extension Act of 2007. We build our quotes based on individual needs and look forward to designing a solution for you.

Conditional Payment Management

Conditional Payment Management

Franco Signor offers conditional payment management that helps you resolve recovery actions by CMS. We combine advanced data-processing technology with our unparalleled MSP expertise to provide a strategy that satisfies CMS requirements for conditional payment recovery. Let us provide you with easy-to-understand steps that resolve conditional payment matters quickly.

BCRC/CRC Notification/Medicare Verification

Obtaining Medicare beneficiary status and notifying the BCRC of the injury is one of the key steps to initiating MSP Compliance. Franco Signor will contact the BCRC to verify the claim record is on file with Medicare and if not, report the information. We will then follow up to ensure the claim has been added by the BCRC and transition to the MSPRC (Medicare Secondary Payer Recovery Contractor).

Medicare/Social Security Verification

Even if a claim doesn’t involve a Medicare beneficiary, it can be important to know the Social Security status of the claimant. Franco Signor can prepare and file a request with Medicare and the Social Security Administration to determine the injured party’s eligibility status for
both benefits programs.

Conditional Payment Resolution

Medicare can pay for medical items and services immediately after a no fault, liability (including self-insurance), or workers’ compensation claim. When that claim is settled (or a judgement, award, or other payment is secured), Medicare is immediately entitled to reimbursement. Medicare calls these owed payments “conditional payments.”

Franco Signor specialized in conditional payment resolution. Resolving conditional payment issues in an MSP case requires specialized skills and a thorough understanding of the claim, state legislation, and federal regulations. Our team of claims, legal and medical experts will work hand-in-hand with you and your counsel to promptly identify these payments made by Medicare, update it if necessary, negotiate and dispute unrelated recovery amounts, and secure the Demand when the time is right with the MSP Recovery Contractor.

Release and/or Settlement Agreement Review

Our team of in-house attorneys will work with your counsel to review settlement and release language to ensure MSP compliance. Each document will be unique and based on the facts of your case instead of boiler plate form language so commonly provided by other vendors. Since the law makes all parties to a claim legally responsible to pay Medicare it is in the best interests of all parties to get this document right from the start.

Medicare Set-Aside Allocations (MSA)

Workers’ Compensation MSA

Our Workers’ Compensation MSA Allocations (WCMSA Allocations) are built according to CMS guidelines to ensure accuracy. At Franco Signor, we offer industry-leading turnaround times and have the best total dollars submitted to total dollars approved ratio. Plus, we understand the approval process and address issues that might trigger denial—before your WCMSA is submitted.

Evidence Based MSA

Traditional MSA Allocations, which follow recommended CMS regulations, can require unrealistic medical guidelines that cause costs to spiral out of control. Franco Signor’s Evidence Based MSA (EBMSA) uses nationally recognized clinical guidelines to accurately project future medical care for Medicare-covered expenses.

Our EBMSA Allocations are built to satisfy Medicare Secondary Payer Act obligations for both parties. Plus, by eliminating unnecessary Medicare costs on prescription drugs and medical items and services, our EBMSA provides increased settlement opportunities for claims.

Liability MSA

While CMS works on the release of new guidelines for the voluntary review of Liability Medicare Set-Aside Allocations (LMSAAllocations), Franco Signor has developed our own service to protect Medicare’s interest after the settlement of a claim. Future guidelines might not release liability for primary plans, which is why we offer maximum protection for all parties involved under current guidelines.

Non-Submit MSA

Not every Medicare Set-Aside should be submitted to CMS. Let Franco Signor’s expert team help you decide if your claim is right for our Non-Submit MSA. This program can increase settlement opportunities and eliminate unnecessary Medicare costs while protecting Medicare’s interests.

Non-Submit MSA Allocations take advantage of nationally accepted clinical guidelines (such as ACOEG and ODG) to project future medical care for Medicare covered expenses.

Future Medical Cost Projection

Let Franco Signor’s expert clinicians help you project future medical costs for your claims. We will identify the primary cost drivers for both medical and pharmacy costs to help reserve or determine lifetime medical exposure on a case. We provide recommendations and management strategies to control claim costs. FMCP services are billed at a flat rate based on the complexity of the claim.

Life Care Planning

Our expert clinical team can prepare a Life Care Plan (LCP) that projects future medical costs for claimants with catastrophic medical conditions. Franco Signor utilizes a certified life planner to address individual issues and variables in order to maximize independence and improve quality of life. Our LCP services are billed on an hourly basis.

Additional MSP Services

MSP compliance Audit

Franco Signor provides Strategic MSP Compliance Audits for  responsible reporting entities to provide peace of mind and help avoid costly penalties. Our process can identify gaps in your current processes for both data compliance and conditional payment compliance. Talk to Franco Signor today to see if our compliance audit services are right for your company.

MAP/PArt D Lien Resolution

Medicare Advantage Plans (MAPs) and Part D Prescription Drug Plans (PDPs), private insurance companies that offer Medicare coverage to beneficiaries in lieu of traditional Medicare coverage, won the right to recover reimbursements. However, the Commercial Repayment Contractor and the Benefits Coordination & Recovery Center can’t help claimants identify and pay back these private conditional payment obligations.

Franco Signor can identify these private obligations for you. We are the only MSP compliance vendor that can quickly identify the MAPs and PDPs liens associated with your claimant.

PHARMACY MANAGEMENT

Franco Signor provides comprehensive pharmacy management solutions for our clients in partnership with PRIUM. Our expertise in MSP compliance and Mandatory Insurance Reporting combined with PRIUM technology and strong clinically-based pharmacy and case management service support programs for prescription review and peer-to-peer service and medical case oversight.

Professional administration

Professional Administration

Many MSA vendors forget the Medicare Beneficiary in the compliance process. At Franco Signor, we provide compliance solutions for all parties involved—including programs and services to help Medicare beneficiaries manage and maintain allocated funds after claim settlement.

Our CareMDRx service revolutionizes the way Medicare beneficiaries pay for and manage the costs associated with medical and pharmaceutical expenses after an accident. Discover never-before-seen clarity, efficiency, and savings in a traditionally complex and difficult to navigate system.

Assisted Administration

An alternative to our professional administration services, our assisted administration services through CareMDRx is perfect for clients who want to hold funds in their own bank account but want the peace of mind of Franco Signor’s management services. This solution is designed for individuals who are a Medicare beneficiary, reasonably expected to be a Medicare beneficiary in the next 30 months, or not a Medicare beneficiary at all.

Medi-caL Beneficiary Identification

Identifying claimants enrolled in California’s Medi-Cal program has been historically difficult. Franco Signor has developed a service specifically to provide clients with the most current enrollment information available. It’s never been easier to properly identify Medi-Cal beneficiaries.

Medicaid Compliance

Franco Signor offers proven strategies to effectively manage third party liability obligations for Medicaid. Medicaid requires reimbursement from beneficiaries that receive a settlement, judgment, or award for their workers’ compensation, no-fault or liability case for related treatment paid for by the state Medicaid program. While defendants aren’t typically responsible for reimbursement to Medicaid plans for liens, there are exceptions that vary by state.

Additional Claims Services

Covid-19 Claim Services

COVID Reserve Setting Tool (CREST)

The COVID Reserve Setting Tool (CREST) is one of two lines of service we have developed to help clients during the COVID-19 pandemic. CREST provides clients with a high-level overview of the expected costs related to the diagnosis and treatment of COVID-19.

COVID Medical Cost Projection Service (CMCPS)

Estimating the cost of a COVID-19 claim can be difficult due to the varying degree of severity patients suffer, especially those with co-morbid conditions. Our COVID Medical Cost Projection Service (CMCPS) provides a detailed projection of costs utilizing an evidence-based methodology built on actual billed amounts or applicable fee schedules.

Critical Information Identification Service

Franco Signor’s Critical Information identification Service provides clients with missing information needed to identify claims. We can look up either a claimant’s Date of Birth or Social Security Number within minuteseither individually or in batches of up to 1,000 claims at a time.