Medicare Set-Aside Case Study

Medicare Set Aside was reduced from $677,573 to $77,897

Company Name

Company's Relationship with 2020

Genex’s Medicare Set-Aside (MSA) Services assist workers’ compensation payers in meeting this obligation by determining appropriate set-aside amounts and securing Medicare approval. In this case, Genex reduced MSA by 88%.

Industry: Government

Accident Location: Afghanistan

Treatment Location: Savannah, GA

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Injury 

A Medic on a security team in Afghanistan with chronic knee issues was diagnosed with severe stenosis at L4-5 with nerve root compression at L5.  He underwent a L4-5 micro-discectomy and decompression. After the surgery, the IW reported an 80-90% improvement continued to take Flexeril and Duexsis for residual pain.

Solution

Through aggressive Rx intervention, the NCM had the Duexsis changed to the two generic drugs that were much less costly and had Flexeril prescribed in generic form.  All other medications were discontinued.

Outcome

Medicare Set-Aside was reduced from $677,573 to $77,897