2022/08/31 Council Agenda Packet

SCHEDULE 8-A Medicare Set -Aside Services Terms and Conditions I. DESCRIPTION OF OTHER SERVICES a. Medicare Set -Asides: CorVel provides an extensive review of medical records and medical bills, producing a comprehensive report and cost projection outlining future Medicare eligible costs in anticipation of settling out future medical care on a Customer's employee or insured individual. Costs are determined through CorVel's proprietary Bill Review system as well as utilization of the online Red BookTM access for medication costs. Red BookTM is the accepted authority by CMS for pricing on all medications. b. Life Care Plans/Future Cost Projections: Life Care Plans/Future Cost Projections are a plan for optimal utilization of health care dollars that document objective view of the future health needs, services and related costs. It provides for comprehensive reports summarizing medical treatment and care and outlining life time needs for a Customer's employee or injured individual when they are catastrophically injured. Life Care Plans/Future Cost Projections are also used both for litigious settlements as well as projecting reserves setting. c. Medicare Conditional Payment Resolution: CorVel's service includes securing Medicare Conditional Payment letters and disputing the Medicare Conditional Payments unrelated to the claim CorVel communicates directly with the Medicare contractors, the CRC (Commercial Repayment Center) or BCRC (Benefits Coordination & Recovery Center) to resolve the Medicare Conditional Payment debt. II. DELIVERY OF SERVICES OF MEDICARE SET ASIDES a. Customer/Carrier shall provide the CorVel Medicare Set -Aside Hub office with a copy of the first report of injury, most recent two years of medical records and medical bills including indemnity payout, all operative reports, IMEs/AMEs as well as orders rendered by the workers' compensation judicial system. Appropriate releases for completion of request for service will be forwarded either to the Customer or, at the Customer's request, directly to counsel representing the injured worker to obtain the injured worker's signature. b. Customer may submit a request for a Medicare Set -Aside via email, phone, fax, or electronically via CorVel's CareMC website, if applicable. c. A certified Medicare Consultant ("Consultant") will review the medical records and bill summary, prepare a detailed summary of the records and a projection for future medical expense which are Medicare eligible. If requested, the Consultant will also provide a projection of those costs which are not Medicare eligible in order to provide the customer with their total medical exposure. d. The Consultant will return the completed Medicare Set -Aside report to the Customer within fifteen (15) business days of receiving all relevant medical records and related information. If a rated age is warranted, the Consultant will acquire same. If the City of Everett, WA — CorVel EC Amendment 3 7-25-2022