According to an article in The Law Examiner, a Medicare Set Aside or MSA is “a portion of settlement proceeds set aside, called an \u2018allocation\u2019, to pay for future Medicare-covered services that must be exhausted prior to Medicare paying for any future care related to the injury.” In simpler terms, an MSA is essentially your client putting some of the money they receive from a settlement into a separate interest-bearing account. This money is specifically for your client to pay for their Medicare-covered future medical bills related to the injured parts associated with a particular date of injury. Your client needs to appropriately exhaust all of the funds in this account for their injury-related care before Medicare steps in as a primary payer to cover any additional medical costs for that injury. It is imperative that the client only utilize these funds for medical treatment related to the specific incident and it is expected that they will provide an annual attestation with documentation showing exactly what these funds were used to pay for.<\/p>\n

An MSA specifies the precise amount of funds from your client’s settlement that should be allocated to cover Medicare’s future medical interests related to their case. Computing an MSA can be a complicated process that demands thorough documentation; however, when executed correctly, an MSA assures all parties in the settlement that Medicare’s interests have been considered and adequately addressed and protected.<\/p>\n

Covering Future Medical Expenses<\/h2>\n

Negotiating the payment of future medical bills is critical to securing a favorable settlement for your client. Individuals currently receiving Medicare benefits or expecting to qualify for Medicare within the next 30 months must strictly follow established protocols concerning their future Medicare-covered medical expenses.<\/p>\n

The Center for Medicare and Medicaid Services (CMS) reviews MSAs if:
\n\u25cf Your client is a Medicare recipient, and their total settlement exceeds $25,000; or,
\n\u25cf Your client is expected to become a Medicare recipient within 30 months of settlement, and their total settlement exceeds $250,000.<\/p>\n

As an MSA account holder, it’s important to follow the requirement of annually reporting your client’s spending to the CMS. This involves keeping all receipts to support your client’s expenses. Moreover, it’s crucial to ensure that funds from the settlement are solely used to pay for approved medical treatments and prescriptions directly related to the injury.<\/p>\n

Mismanagement of an MSA account, such as overspending on services or using funds for non-qualified expenses, can have serious consequences. This may include reimbursing overspent or incorrectly used funds and the risk of compromising eligibility for future Medicare benefits. Therefore, staying informed about the eligible usage of MSA funds and responsibly managing the account is essential to avoid any adverse outcomes.<\/p>\n

So, how can MD Data help with a Medicare Set Aside?<\/h2>\n

Our team of Medical Direction Experts is equipped with the skills to ensure precise projections of future costs that align with CMS standards. The MSA allocation is one of the first steps in considering Medicare’s future interests. To develop a thorough report with a recommended allocation amount, we will comprehensively review your client’s case. This will involve reviewing the first report of injury, the last two years of medical care related to the incident, the last two years of pharmacy history as well as the last two years of bills related to the incident. Following this in-depth review, anticipated future medical treatment is extrapolated and allocated in accordance with guidelines provided in the most recently published \u201cWorkers Compensation Medicare Set Aside (WCMSA) Reference Guide\u201d with pricing per the prevailing fee schedule or specific pricing guidelines according to the jurisdiction as outlined in the WCMSA Reference Guide. If requested by the client, a rated age can be obtained, which would reflect any necessary reductions in life expectancy based on co-morbid conditions.<\/p>\n

At MD Data, we have an outstanding record for providing accurate and timely MSA allocations, allowing settling parties to confidently proceed with their settlement, knowing that Medicare\u2019s interests have been considered. MD Data’s expert team includes certified professionals who all hold the industry gold-standard certification, Medicare Set-Aside Certified Consultant (MSCC) through the International Commission for Health Care Certifications (ICHCC), have experience preparing hundreds of MSAs, have worked at the administrative level with the Workers Compensation Review Contractor (WCRC), are considered subject-matter experts and our Director additionally serves as a Commissioner for the MSCC branch of ICHCC. This unique and high level of experience ensures precise MSA allocations that meet CMS standards, avoid overinflation and ensure approval. We are also highly skilled if there is ever a need for a Re-Review or Amended Review and will assist our clients along every step of that process.<\/p>\n

With a deep understanding of CMS guidelines, we efficiently navigate any encountered complexities and provide guidance and communication throughout the development of the MSA as well as submission to CMS for approval if desired by the client. Choose MD Data for unparalleled proficiency and dedication in the intricate landscape of Medicare Set-Aside consulting! Contact us today or email us directly at info@mddata.com.<\/p>\n","protected":false},"excerpt":{"rendered":"

According to an article in The Law Examiner, a Medicare Set Aside or MSA is “a portion of settlement proceeds set aside, called an \u2018allocation\u2019, to pay for future Medicare-covered services that must be exhausted prior to Medicare paying for any future care related to the injury.” In simpler terms, an MSA is essentially your […]<\/p>\n","protected":false},"author":4,"featured_media":1913,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","rank_math_lock_modified_date":false,"footnotes":""},"categories":[38,39],"tags":[],"class_list":["post-1910","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicare-set-aside","category-msa"],"_links":{"self":[{"href":"https:\/\/mddata.com\/wp-json\/wp\/v2\/posts\/1910","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/mddata.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/mddata.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/mddata.com\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/mddata.com\/wp-json\/wp\/v2\/comments?post=1910"}],"version-history":[{"count":3,"href":"https:\/\/mddata.com\/wp-json\/wp\/v2\/posts\/1910\/revisions"}],"predecessor-version":[{"id":1914,"href":"https:\/\/mddata.com\/wp-json\/wp\/v2\/posts\/1910\/revisions\/1914"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/mddata.com\/wp-json\/wp\/v2\/media\/1913"}],"wp:attachment":[{"href":"https:\/\/mddata.com\/wp-json\/wp\/v2\/media?parent=1910"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/mddata.com\/wp-json\/wp\/v2\/categories?post=1910"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/mddata.com\/wp-json\/wp\/v2\/tags?post=1910"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}