Medicare Set-Asides

Per the Medicare Secondary Payer Act, the Centers for Medicare & Medicaid Services (CMS) demands that their interest be taken into consideration when settling cases where the settlement funds include payment for future medical care. If not, Medicare can take legal action to recover funds and Medicare benefits can be negatively impacted in the future. In certain cases, Medicare strongly recommends that future related Medicare allowable medical care be set-aside from the settlement funds and Medicare review/approve the adequacy of the amount. This is the conception of a Medicare Set-Aside (MSA). The MSA Allocation is a detailed report which determines future medical care and what is acceptable/covered by Medicare. During the settlement process, it is imperative that you understand when and how the case should be evaluated to assure Medicare’s interest has been taken into consideration. Medicare Set-Aside Allocations includes several components: Medicare confirmation/lien verification and reporting, Medicare Set-Aside Arrangement (MSA), submission to the Centers for Medicare & Medicaid Services (CMS), and funding/administration of the MSA. Depending on the nature of the case, all components or specific components of the MSA process can be completed for the referral source.