Many professions are governed by a code of ethics. A code of ethics is intended to ensure that professionals act responsibly and are open to correction. Medicare Set-Aside allocations may be provided by a variety of professionals such as nurses, claims handlers and attorneys. This article will explore the ethical concept of neutrality related to Medicare set aside (MSA) preparation and the allocators need to strive for accuracy.
In order to prepare a Medicare Set-Aside, the allocator must have access to the tools needed to accurately project future treatment. The allocator should also understand medical and legal concepts and know when to seek assistance. Each allocation should also be based on an individualized medical treatment plan. A good working knowledge of current CMS WCMSA Guidelines, federal laws and applicable state laws is essential in order to prevent errors of omission.
It is also important to remember that Medicare Secondary Payer compliance vendors and allocators are guiding insurance carriers in making critical financial decision around the MSAs that are being offered in connection with settlements. Injured workers/clients will also need to rely on these funds to pay for medical treatment. Providing services outside of one’s professional expertise can cause oversights and unintended consequence. Above all, an allocator should be competent. This includes maintaining credentials, staying current with education/training as well as being involved in the national organizations that support this competency.
Ethical neutrality is explained by Max Weber (2017)* where he discusses that “Every professional task has its own 'inherent norms' and should be fulfilled accordingly. In the execution of his professional responsibility, a man should confine himself to it alone and should exclude whatever is not strictly proper to it—particularly his own loves and hates” p.48. Most of us swore an oath to perform our duties without bias. This is the bar that has been set for all the stakeholders to reach.
For additional reference: Link to MSPN Standards of Practice.
*Weber, Max (2017). Methodology of Social Sciences
Innovative Claims Strategies (ICS) is a leading national Managed Care Service company headquartered in Piscataway, New Jersey that designs, implements and manages customized Integrated Medical Cost Containment and Technology service models to the Public and Private Sector Markets, Risk Pools, State Funds, Insurance Carriers, Third Party Administrators, Self-Insured/Self-Administered Employers, and the Transportation Industry. ICS is a national provider of risk management solutions for employers, third party administrators, insurance companies, and government agencies seeking to control costs and promote positive outcomes. ICS services include 24/7 Call Center, Nurse Case Management, Vocational Case Management, MSP Compliance services, Bill Review and PPO icing and Concurrent Prospective Retro UR Program.
Email to a Friend
