Medicare Set-Aside Services

GFRG provides Medicare Set Aside (MSA) evaluation and allocation services to help settling parties in single event and mass tort litigations ensure absolute Medicare compliance at the time of settlement. GFRG’s Future Cost of Care group works with claimants and carriers to determine whether a Medicare Set-Aside is appropriate and if so, how much the Medicare Set-Aside allocation should total. 

 

Having been engaged by both claimants and carriers on thousands of cases directly involving Medicare compliance obligations, GFRG has the knowledge, experience and compliance protocols in place to handle a case from the initial Medicare Set-Aside evaluation stage through the Medicare Set-Aside allocation and Medicare Set-Aside proposal stages to submission and approval of the Medicare Set-Aside proposal from the Centers for Medicare & Medicaid Services (CMS) when appropriate.  

 

Unlike others in the marketplace who claim to be the nation's most trusted provider of Medicare Compliance Services, GFRG understands when a Medicare Set-Aside is needed versus when a Medicare Set-Aside is not needed.  For example, did you know… 

 

     ·“Considering” Medicare’s future interests does not always mean setting settlement proceeds

      aside in a Medicare Set-Aside?

     ·MSAs are not appropriate unless the claimant possesses the requisite Medicare entitlement

      status (either currently entitled to Medicare or possessing a “reasonable expectation” of

      Medicare entitlement within 30 months of settlement)?

     ·CMS does not require a MSA proposal to be submitted for review and approval?

     ·While usually appropriate as a part of your Workers’ Compensation settlement, MSAs are rarely

      appropriate as a part of a 3rd Party Liability settlement?

 

In addition to providing guidance on Medicare Set-Asides, GFRG helps the settling parties document their files and memorialize the fact that they are considering Medicare’s interests at the time of settlement by obtaining an independent, neutral 3rd party case evaluation.

 

GFRG understands that proper Medicare Set-Aside evaluations, whether related to a Workers’ Compensation settlement or a Third Party Liability settlement, should contain both medical and legal analysis. Settling parties routinely rely on GFRG’s knowledge, experience and compliance protocols when asking us for a MSA evaluation. They know that a MSA evaluation completes the Medicare compliance puzzle, and that GFRG provides the most accurate and compliant way to achieve absolute Medicare compliance.

 

Frequently Asked Questions Regarding Medicare Set-Asides

 

What is a Medicare Set-Aside?
A Medicare Set-Aside is an account is created in the settlement of a workers' compensation or liability case. It is funded using a portion of the settlement proceeds that is to be used to pay for future medical expenses related to the job injury/illness that would otherwise be payable by Medicare. Funds must be established in insured accounts and may be managed by the claimant or set up in a custodial account.

 

Why Are Medicare Set-Asides “Required”?
On December 5, 1980, the Medicare Secondary Payer Act extended Medicare's secondary benefit payer status to liability claims.  The Medicare Secondary Payer Act assures that Medicare will always be the secondary payer whenever payment has been made, or can reasonably be expected to be made, under a workers compensation policy or plan and a liability insurance policy or plan (including self-insured plans).  While these laws have been in place since 1980, very little enforcement of the statute occurred until budget concerns surrounding Medicare’s longevity surfaced.  As a result, in July 2001, CMS began publishing a series of policy memoranda that discussed the use of Medicare Set-Asides in workers’ compensation cases. It is based on these CMS policy memoranda, when read in conjunction with the Medicare Secondary Payer Act and the affiliated federal regulations, that Medicare Set-Asides are “required”.

 

When are Medicare Set-Asides recommended in workers' compensation cases?
MSAs are recommended when the injured worker's settlement includes payment for future medical care which would otherwise be payable by Medicare.

 

When may a Medicare Set-Aside proposal be submitted to CMS in workers' compensation cases?
MSAs may be submitted to CMS when:
     • The injured/ill worker is, at the time of settlement, currently on Medicare and the total settlement

        value is over $25,000; or
     • The total settlement value is at least $250,000 and the injured worker is reasonably expected to

        become entitled to Medicare within 30 months of settlement.

 

When are Medicare Set-Asides recommended in liability cases?
The rules are different for using a Medicare Set-Aside in a liability settlement compared to using a Medicare-Set Aside in a workers’ compensation case.  Misinformation in the marketplace has created unnecessary angst between claimants and carriers on this question.  We suggest that the question should be answered on a case-by-case basis based on the case-specific facts.  Our Medicare Set-Aside services are designed to help both claimants and carriers document their file and memorialize their efforts at considering Medicare's interests.

 

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| Medicaid | Medicare | Medicare Set-Aside | MSA | MSAs |