What Physicians Need to Know About Medicare Set-aside Accounts

MSA Overview

When workers’ compensation or personal injury patients settle their cases, they may be required to place a portion of their settlement into a special account – called a Medicare Set-aside Account or MSA Account -- which is intended to cover their medical expenses for the lifetime of their injury.

MSAs were created to prevent insurance carriers from inappropriately shifting the post-settlement financial burden for the injury to Medicare. As a protection for the American tax payer, Congress and Medicare have instituted a number of laws, policies, acts and regulations which limit how the funds in an MSA Account can be spent and restrict the account to use for only injury-related medical expenses.

MSA Accounts have other restrictions as well, including determinations for what qualifies as a Medicare-covered service or medication for a particular diagnosis, and pre-determined pricing allocations for medical services, medications and supplies.

The Centers for Medicare and Medicaid Services (CMS) has specific rules regarding which injury-related expenses (doctor’s visits, medications, tests, procedures, hospitalizations, supplies, certain durable medical equipment, etc.) are covered and can be paid from the MSA Account. CMS also approves a pricing method which dictates how much can be spent for each service and medication and requires patients to report all expenditures annually. For more detailed information about MSA’s, please visit the About MSA Accounts in the Attorney section of this website.

The guidelines and restrictions for MSA Accounts are quite detailed and sometimes difficult for patients to manage on their own; however improper management can jeopardize a patient’s future Medicare eligibility for injury expenses; this is why MSA-meds offers professional MSA Account administration to patients. While other companies charge thousands of dollars to manage MSA Accounts, we do not charge for MSA administration; we offer it as a value-added service to our eligible pharmacy clients.

Relevant Information for Physicians

The detailed rules, regulations and reporting requirements for MSA Accounts are frequently changed, amended or updated – and nearly impossible for doctors or patients to keep track of -- which is why MSA-meds handles all the details. However here are some important points for doctors to be aware of:

  • MSA allocations for doctor’s fees are generally reasonable and are usually significantly higher than Medicare reimbursements.
  • All pricing for medical services paid through Medicare Set-aside Accounts is pre-determined according to the pricing method approved by CMS when the Medicare Set-aside Allocation was submitted. To continue treating a patient post-settlement, physicians must be willing to accept the price approved by CMS.
  • Not all medications and services are approved for all injuries, so when prescribing for your post-settlement patient, you may need to consult with an MSA administrator to determine what is covered. MSA-meds is happy to pre-approve your patients’ treatment.
  • The MSA-meds billing process is much simpler and pays much more quickly than Medicare, workers’ compensation or most insurance companies.

To refer a patient or learn more about how your practice can retain post-settlement patients and receive timely payments from their Medicare Set-aside funds, please visit How Our Service Works, or call us or email us. . 1-855-MSA-MEDS (855-672-6337)

If you would like to join our Network of Physicians who receive referrals of patients with MSA Accounts, please call us at 1-855-MSA-MEDS or email us.