As of January 1, 2006, Medicare began covering prescription medications through Medicare Part-D.  This new coverage drastically increased the costs of Medicare set-asides. In an effort to reduce these expenses, Protocols, LLC now offers Drug Utilization Reviews (DURs).

Protocols^® works in conjunction with the services of Greg Krivec, an experienced full-time consultant pharmacist, dubbed the "Poisons Analyst" by his professional peers.  Our DURs offer a complete review of case-specific medications specifically focusing on contra-indicated drugs, length of time medications are used, and drug alternatives, in an effort    to    streamline   medication

projections.  The final goal of our DURs is to identify medication overuse, misuse, and underuse and cost effectiveness.

We guarantee a one-week turnaround time for our DURs; the cost is a flat fee of $500.00 per DUR.

To obtain a DUR on a new submission, please check the appropriate box on our MSA submission form.  To obtain a DUR on an existing case with our firm, please contact us.

Please contact Geraldine Dauby for further information.

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Our firm recently changed our e-mail addresses.  Instead of firstname@shdcolorado.com, our addresses are now firstname@protocolsllc.com.  We will receive messages to our previous addresses for a limited time, so please update your records accordingly.

Furthermore, in our continuing efforts to improve our services to you, Protocols^® now offers expanded business hours.  Our consultants will be available via telephone from 9:00 AM through 7:00 PM Eastern Standard Time, Monday through Friday.

Please contact Christopher Newton for further information.

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Question of the Week - CMS Approval of Previously-Settled Claims

This question was posted on our blog.

Q:  I hear that CMS is requiring parties to revisit settlements that were done prior to 12/31/2005 to address prescription medications. Specifically, I understand that if a Medicare set-aside proposal does not include funding for prescription drugs the Medicare set-aside allocation must be recalculated and re-submitted to CMS for approval regardless of the fact that the claim settled prior to 12/31/05. This is true for cases that were settled before that date but were not approved by CMS before that date. What is your take on this issue?

A:  Good question! Legally, CMS’ position raises several concerns. In the past, CMS issued numerous written and oral statements that medications need not be included in Medicare set-asides until further notice. However, CMS finally gave official notice at the last minute on December 30, 2005, stating that only those settlements that occur on or after January 1, 2006, need to include prescription medications.

CMS has since contended that settlements  that  occurred  prior to

January 1, 2006, but not submitted for review until after January 1, 2006, must include prescription medications in the set-aside. This position is invalid for several reasons, some of which include:

• CMS’ official notice did not occur until December 30, 2005 and the notice cannot be retroactive;
   

• CMS’ notice treats similar settlements differently in an arbitrary manner;
   

• CMS’ new guidance contradicts its previous written and oral guidance;
   

• Overall, CMS is attempting to exceed its legal authority (although as we know CMS tends to wrongfully think it has absolute authority).

If you have questions concerning a specific case, please contact us and we can discuss the specific issue as well as possible remedies.

Please contact Henry Kohnlein, attorney, for further information.

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Kara Martin, Attorney, Joins Protocols, LLC

Protocols' unparalleled legal expertise continues to grow with the addition of our newest attorney, Kara Martin.  Specializing in a variety of legal issues, including workers'   compensation,   Medicare

and Medicaid, Kara comes from our affiliated law firm of Sagrillo Hammond Dineen & Poskus, LLC.

To read more about Kara, click here.

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Protocols^® guarantees 12-business day turnaround for new MSA referrals (20 days for complex cases) from the date we receive all necessary information.  To help ensure prompt results for your referrals, we offer the following tips:

1. Take advantage of Protocols' electronic submission form.  The form allows electronic document submission, which can reduce mail-time delays.
   
   Alternatively, when sending a referral by mail, please be sure to use our most current submission form.  Our forms are located here.
    

2. E-mail an electronic version of the payment history to info@protocolsllc.com rather than sending a hard copy on paper.  When we receive a hard copy, we must enter the information by hand, which adds additional work to our analysis.

3. Please provide as much documentation as possible relating to the claimant's work injury, including  medical records and rated age quotes (if desired).
   
   Remember, Protocols^® will obtain rated age quotes for you per your request.
    

4. Please provide the claimant's indemnity information (or average weekly wage) as specified on the submission form.

Remember, Protocols^® is devoted to streamlining the Medicare set-aside process and making your job easier.  If you would like us to visit your office and copy files, complete submission forms, or provide other assistance in the preparation of referrals, please don't hesitate to contact us.  We're here for you!

Please contact Eddie Phillips for further information.

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Our Staff Spotlight intends to help our clients get to know the people behind Protocols.  This month's spotlight focuses on Amy Ettinger, one of Protocols' newest Case Managers.  Originally hailing from Pittsburgh, Pennsylvania, Amy received her B.S. in Psychology from the University of Florida.  Later, Amy moved to Denver and earned her Paralegal Certificate, and prior to joining Protocols, she worked as a paralegal for Child Support Enforcement.  Amy is a self-proclaimed Stained Glass artist, and in her spare time she also enjoys jewelry making, hiking, and traveling.

Please contact Amy Ettinger for further information.

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