Medicare Magic Number Calculator
*
Determining how to protect Medicare’s future interest when CMS review is not an option ___ A work injury has been established. (3 points)
A full recovery opinion exists. ___ (1 point)
___ The established work injury is significant or expensive. (1 point)
The treating doctor has provided a full recovery opinion. ___ (1 point)
___ A significant new claim/description/expansion concern exists. (3 points)
There is no formal allegation of this injury expansion issue. ___ (2 points)
___ The new injury is potentially catastrophic. (1 point)
A factual defense to a disputed claim exists. ___ (1 point)
___ Future treatment is indicated. (0-3 points) 0
1
None
2
A strong factual defense to disputed claim exists. ___ (1 point)
3
Maintenance
Active Care
Major Care
(OTC Rx, Home Exercise, etc.)
(Prescription Rx, Doctor Visits, Multiple Diagnostics, etc.)
(Surgery, Expensive Long Term Rx, Hospitalization, etc.)
A medical defense to future liability exists. ___ (1 point) A strong medical defense to future liability exists. ___ (1 point)
___ Claimant is Medicare eligible. (5 points) ___ Claimant expects to be Medicare eligible within 30 months. (1 point)
Only nominal future treatment is indicated for work injury. ___ (1 point)
___ There is a belief that CMS made a conditional payment. (1 point)
An MSA report recommends a zero dollar set-aside. ___ (3 points)
___ An MSA report/recommendation has already been prepared.
Total ________ (Column B)
________ Total (Column A)
__ _______________
______________
Column A Total
=
Column B Total
__________________________ Medicare Magic Number
Medicare Risk Range Finder -1
0
1
Do Nothing
2
3
4
5
6
7
8
Earmark
9
*
10
11
12
Informal WCMSA
* This is merely a tool to help identify and consider some key issues when determining the extent of Medicare’s future interest and how to protect the same when Medicare’s Review Threshold is not implicated. It is not a guarantee of protection from liability to Medicare. This is not legal advice. Please contact a C&W attorney for legal advice or to address and questions or concerns.
PITTSBURGH
HARRISBURG
SCRANTON
PHILADELPHIA
MARLTON
(412) 563-2500
(717) 975-9600
(570) 347-0600
(610) 567-0700
(856) 761-3800
WWW.C-WLAW.COM
© 2010 Cipriani & Werner, P.C.