Ensuring a favorable and appropriate Medicare Set-Aside (MSA) decision is the result of careful attention to the thousands of relevant details that are generated by the underlying legal case, whether it is a Workers’ Compensation (WC) claim, a No-Fault case, or a disputed Liability claim. Without an accurate MSA determination, the injured person, their insurer, their employer, and Medicare each face the prospect of incurring future medical costs related to the injury that should have been negotiated and resolved within the underlying legal claim. An MSA gives each party to the case a resolution to their rights and obligations as those relate to the interests of the others, and gives the case appropriate and final closure.
Assurance from Start to Finish
At CompEx MSA, we evaluate and manage the MSA case through all three of its stages:
- We confirm the claimant’s Medicare eligibility;
- We investigate:
- All medical services and treatments to find obstructions to settlement;
- Any potential liens that might arise, including those that are not appropriate to the MSA claim;
- All appropriate services and supports at levels that address future care allocations, and
- Any appropriate rated-age determinations.
- We provide a comprehensive analysis of all relevant medical records and related Medicare payments, including contacting physicians and medical personnel for documentation and confirmation;
- We manage Conditional Payment Notices through to an appropriate resolution of those issues, and
- We submit a proposal that best encompasses appropriate MSA amounts, including estimates of life expectancies and the possibility of Medicare liens.
- If necessary, CompEx MSA will seek additional information regarding the potential need for annuities, custodial or trust agreements;
- We submit the settlement proposal to CMS, including a full discussion of the allocation amount, the funding method, and the administration method;
- We will work with Medicare to resolve outstanding liens, and to gain approval of the MSA Arrangement.
Once the case is fully resolved and all agreements are in place, CompEx MSA case management services streamline the administrative processes and costs while managing the account on behalf of the parties, including:
- making appropriate cash disbursements;
- issuing required reports;
- ensuring compliances, and
- recapturing medical expense claim dollars when the claim terminates.
While Avoiding Costly Mistakes
Mistakes happen, but if an error affects Medicare’s right to reimbursement or subrogation, that agency has laid out possible penalties to prevent it, and its constituents, from inappropriately paying for healthcare services that are rightly the obligations of another carrier. At the least, Medicare can deny payments for the injuries until the full amount of the legal settlement is exhausted. At the worst, the agency can refuse to pay any medical expenses for the condition, and may even seek double damages against all parties if negligence or intentional malfeasance is involved. 42 CFR Section 411.40 and 42 CFR Section 411.46
Accordingly, ensuring an appropriate and proper resolution to the underlying injury case protects each of the claimant, their insurer, their employer, and Medicare. When the MSA is properly administered, there is no danger that Medicare might deny claims for this or future healthcare costs.
CompEx MSA is your trusted and comprehensive Medicare Set-Aside and Compliance Provider.