Most employers with injured workers are adept at managing the Workers Compensation case to a satisfactory settlement, including procuring a Medicare Set-Aside (MSA) agreement. Once the case settles, however, managing the resulting MSA account can take as much or more time for the claimant to administer as did the original case.

The MSA agreement protects the interests of both the Claimant and Medicare. For the Claimant, the agreement ensures that there is money available to cover the costs of future medical services rendered for the subject injury. For Medicare, the MSA ensures that its interests have been properly managed in the underlying case, and that it will not be making payments for services that are not rightly its responsibility. Proper administration of the account ensures that the interests of both the Claimant and Medicare are protected for the life of the agreement.

As in most government related interactions, the MSA agreement requires ongoing proof that the money is being used appropriately and only for the subject injury, and that documented proof of those facts must be submitted to CMS on a regular basis. Many claimants are unfamiliar with the processes and procedures required by Medicare when reporting MSA data, but even small glitches or gaps in documentation have the capacity to stall the account. Consequently, many claimants, and the employers who assist with set-up of the MSA account, access the services of a professional Medicare Set-Aside agent to coordinate the data and make timely and proper reports on their behalf.

Expertly Managing Every Case

Since 2000, the administrative professionals at CompEx MSA have provided the best case management option to ensure that the health of the injured worker is restored as quickly as possible, and that the interests of CMS (the Centers for Medicare and Medicaid) are protected throughout the process. By encouraging the use of a professional MSA agent, employers and insurers are also protecting their own entity from future concerns that might arise if those agreements are improperly managed, and.or if Medicare and CMS don’t receive appropriate reports on behalf of the Claimant. The Custodian ensures the file is managed according to Medicare guidelines and that neither the insurer nor the employer is at risk of violating the terms of the agreement.

At CompEx MSA, our professional administration service providers ensure that each MSA is managed comprehensively and appropriately, according to its terms and CMS rules:

  • We ensure the MSA bank account fits the criteria required by MSA rules

  • We help clarify which expenses are proper to be drawn from the account, and which are not

  • We will assist health care providers to establish appropriate billing documents that contain only approved prices and that conform to the MSA requirements

  • Whenever possible, we will seek discounts and other options that provide the best care for the best price

  • We manage the payment process so that all appropriate providers, including doctors, therapists, hospitals, and others, get paid for their services only from the MSA account,

  • We sort and record all documentation, including receipts, to ensure accuracy of reporting

  • We produce the annual reports that describe the activities of the funds throughout the year

  • We will assist with any modifications that may be required, including in the event the Medicare status changes. In the event the MSA is exhausted before the injury fully resolves, we will also help to establish the needed CMS support.

Ensuring Future Compliance, Too

Additionally, CompEx MSA also tracks MSA rules as they change over time. Recently, the agency has issued new LMSA rules that appear to suggest more rules are coming; many of our current clients will be affected by these and future regulations. Accessing CompEx MSA’s professional administrative services will keep both current and future clients in compliance with both current and future rules and regulations.

There are always questions that arise as the MSA process continues and CompEx MSA’s professional account managers are always available to assist with finding answers and resolving issues.