We Take The Guesswork Out of Medicare Set-Asides

Medicare Set-Aside Blog on January 7, 2008 | Posted by


   


 There are a lot of questions surrounding Medicare Set-Aside arrangements


“When do I need to consider a Medicare Set-Aside arrangement?”


The answer: Most people only consider the review threshold when evaluating the need for an MSA. We all know the two part test…(Test 1) If the claimant is currently a Medicare beneficiary AND the settlement is in excess of $25,000;   or  (Test 2) The claimant has a reasonable expectation of becoming entitled to Medicare within 30 months AND the total settlement is in excess of $250,000. However, the correct answer is that you ALWAYS need to consider Medicare’s interests, even when the case does not meet the review threshold. You may not need a full-blown MSA, but some consideration is always appropriate. Call one of our attorneys with questions.


How does CMS evaluate the sufficiency of a Medicare Set-Aside arrangement?


The answer: Medicare considers the sufficiency of an arrangement on a case by case basis. Some factors they consider include: basis for benefits to Medicare, nature and extent of the injury, age and workers’ compensation classification of the beneficiary, prior medical expenses paid by the workers’ compensation carrier, and the total amount of the settlement. MEDVAL’S staff of nurses and attorneys thoroughly review the medical records, consult with the settling parties and treating physicians, and  make recommendations that we believe  adequately protect Medicare’s interests.


When should I consider professional administration for a  Medicare Set-Aside arrangement?


The answer: A professionally administered MSA is used when a beneficiary is unable or unwilling to comply with the many requirements set forth by Medicare for managing the Set-Aside arrangement post-settlement. A professional custodian, like MEDVAL, ensures proper investment, makes payment to medical providers, reduces bills to the appropriate state fee schedule if necessary and submits the required accounting to CMS on an annual basis.



You can visit our Frequently Asked Questions page or contact us directly.

    MEDVAL     1-888-SET-ASIDE (1-888-738-2743)

    Medicare Set-Aside Allocation/Arrangement Recommendations
    Submissions to Centers for Medicare and Medicaid Services
    Post-Settlement Administration

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