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Solutions
for Medicare Set-Aside Program
MSA Services
What
is a Medicare Set-Aside?
Medicare set-aside allocation is an agreement that
takes place at claim settlement. It prevents the shifting of burden for future injury-related medical expenses
from the carrier to Medicare.
What Is Involved In The MSA Allocation
Process?
The
medical records are reviewed and a determination is made as to what the future medical needs related to the injury are, and
whether they are covered by Medicare.
Using the information gathered, an amount for the set-aside is determined.
This amount could include money for: Durable Medical Equipment, Doctor Visits, and Prescription Medications.
Our Professional Medicare Set-Aside Experts provide:
- Comprehensive review of medical records.
- Review medical payment history (for current Medicare
recipients).
- Outline physician recommendations.
- Review pertinent standards of care.
- Establish allocation amount.
When Are You Required
To Submit an MSA?
Class I - The individual is
a Medicare beneficiary at the time of settlement, regardless of the amount of the settlement. Class II - The individual is not a Medicare beneficiary at the time of settlement,
but the following two-prong test is met:
A. The total amount of the settlement is over $250,000.
B. There
is reasonable expectation of Medicare enrollment within 30 months of the settlement date.
Consequences For Failing to Obtain an MSA?
Failure to protect Medicare’s
interests may result in double damages being assessed against the party(s) responsible. This could include
the Insurance Company, the attorney and even the claimant.
Who Completes
The MSA?
Completing a Medicare set-aside allocation is a detailed process that requires the right tools.
This should be done by professionals such as those at Cost Containment Solutions who are experienced in the allocation
process.
Cost Containment Solutions Medicare
Set-Aside Services
Medicare
Set-Aside Allocation Cost Projection completed and submitted for approval by Center for Medicare and Medicaid Services (CMS).
1.
Required
Release of Information forms obtained.
2.
Social
Security and Medicare Status Determination.
3.
Medicare Set-Aside
Allocation cost projection and recommendations.
4.
Life
expectancy projection.
5. Obtain approval of the adequacy of the MSA arrangement
from (CMS).
6. Perform Medicare conditional payment lien status
verification.
7. Rush Services (MSA allocation completed within
5 business days).
8. Medicare conditional payment lien negotiation.
9. Medicare conditional payment negotiations.
10. Copy and Pick up files.
Call Cost Containment Solutions for further information
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