MSA Professional Administrators

Why Do I Need A Professional MSA Administrator?

MSA funds must be spent according to CMS guidelines or future Medicare benefits will be jeopardized.

The Centers for Medicare and Medicaid Services (CMS) has set forth a series of guidelines governing how funds in Medicare Set-Aside Accounts must be expended. If the MSA funds are not properly expended, Medicare may deny future coverage for injury-related care.

CMS guidelines for spending MSA funds on prescriptions and other medical expenses are extremely specific and quite onerous. For example, your clients must:

  • Pay only for medical bills incurred for the exact injury that is the subject of the Workers’ Compensation case
  • Reprice bills according to the pricing method approved by Medicare before payment
  • Submit a yearly accounting of all expenditures from their MSA Account to Medicare, including receipts
  • Determine which medications are Medicare-covered expenses
  • Contact their doctor to find an appropriate substitution if the medication is not a covered expense
  • Monitor ongoing medical treatment and review any newly prescribed medications to ensure compliance with CMS regulations
  • Find a pharmacy willing to accept payment based on the pricing method selected in the MSA documents and approved by Medicare

Maintaining compliance with numerous MSA Account regulations is overwhelming for most clients. However, failure to follow every guideline can jeopardize your clients’ future Medicare eligibility for injury-related care. MSA Meds ensures that your clients’ MSA Accounts comply with CMS requirements by:

  • Reviewing all of the MSA and settlement documents
  • Establishing your client’s MSA bank account is in accordance with CMS guidelines
  • Negotiating pricing contracts with all medical providers to ensure that only MSA-approved prices are paid for all medical treatments
  • Verifying that all medical bills are for services related to the injury and covered by Medicare
  • Paying all properly submitted and documented medical bills
  • Providing documentation of MSA Account activity to your clients quarterly
  • Maintaining all expenditure records and receipts
  • Submitting the Annual Accounting to CMS (Centers for Medicare and Medicaid Services)
  • Safeguarding all records, including advanced disaster offsite backup of all files and copied documents

MSA Administration is too onerous for non-MSA professionals

To properly administer a MSA Account, a thorough knowledge of ICD 9/10 Codes, CPT Codes, and FDA Drug Indications is required. In addition, access to costly pricing Databases is needed.  CMS realizes that the rules to properly administer a MSA Account are very complicated and has recommended professional administration in all cases.

17.1 Administrators

WCMSAs should be administered by competent MSA Professional Administrators (a Professional Administrator, the representative payee, the Claimant, etc.). When a Claimant designates a representative payee, appointed guardian/conservator, or has otherwise been declared incompetent by a court; the settling parties must include that information in their WCMSA proposal to CMS. CMS highly recommends professional administration where a Claimant is taking controlled substances that CMS determines are “frequently abused drugs” according to CMS’ Part D Drug Utilization Review (DUR) policy. That policy and supporting information are available on the web.

Claimants may also administer their own WCMSAs if State law allows. Claimants should submit annual self-attestation, just as a Professional Administrator would. This arrangement is subject to the same rules and reporting requirements as any other WCMSA. See section 17.5 for more on this annual attestation. Although beneficiaries may act as their administrators, it is highly recommended that settlement recipients consider the use of a Professional Administrator for their funds.

MSA Professional Administrators – Contact Us Today!

MSA Meds provides a team of Certified Medicare Set-Aside Professionals to ensure that your MSA Account is properly administered. We provide the peace of mind that Medicare will pay bills for injury-related care if your MSA funds are all spent. Call MSA Meds or contact us today to learn how we can protect your future injury-related Medicare benefits!