Medicare Set-Aside (MSA's)
CMS ( Centers for Medicare and Medicaid Services) recommends that parties to a Worker’s Compensation settlement set aside funds for all future medical services related to the Worker’s Compensation injury or illness that would otherwise be reimbursable by Medicare. A Medicare Set-Aside Arrangement protects Medicare’s interests when settling future medical benefits for qualified individuals and prevents the shift of burden from the primary payer to Medicare.
MEDICARE SET ASIDE SERVICES:
- Review of Medical Records
- Review of Payout History
- Report preparation
- Breakdown of Medicare and non-Medicare costs
- Based on CMS guidelines
MSA SUBMISSIONS SERVICES:
- Send appropriate forms to claimant attorney, defense attorney and CMS, including SSA-3288, Medicare release of information form, and general release forms to verify Medicare eligibility and lien status.
- Obtain and organize all information as per CMS guidelines
- Transfer of files to CD-ROM format
- Monitor and follow-up with the lead contractor on submission status until the file is approved by CMS.
CONDITIONAL PAYMENT LIEN RESOLUTION SERVICES:
- Obtain information on conditional payments made from CMS
- Audit for accuracy and send corrected list of claims to CMS
- Obtain final payment demand from CMS
PMOA MEDICARE SET-ASIDE SERVICE COMMITMENT:
- MSCC Professional Nurses complete MSA process to include on-going communication with client to move file to settlement
- PharmD reviews and prices all prescriptions
- Reports meet CMS requirements resulting in higher CMS Submission rate
- 10 day turnaround time
- All MSA's are one flat rate with NO HIDDEN FEES
- NO CHARGE FOR RUSH CASES!
