CMS requires all Medicare Set-aside (MSA) funds to be deposited into an interest-bearing account separate from other personal checking or savings accounts. For lump sum settlements, there will be a one-time deposit. For structured settlements or annuity payments, there will be an initial deposit at the time of settlement and then periodic deposits (usually annually) for the life of the injured worker. Any unused funds from one year must roll over to the next year. Read on and contact our team to learn more about the banking requirements for Medicare Set-aside accounts.
What banking requirements does CMS mandate for MSA accounts?
Only funds designated specifically for the MSA should be deposited into the MSA Account. If your settlement included costs for professional administration, these funds must be kept separate and not deposited into the MSA Account. You may have also received settlement dollars for non-Medicare-covered treatment. If so, these funds should also not be deposited into the MSA Account.
Once the MSA Account is established, bills must be processed through the MSA Account according to Medicare’s strict rules for payment. Some of the rules include only paying for medical treatment, as well as prescriptions, related to the work injury and only paying for treatment that would otherwise be covered by Medicare. There are also specific rules for Part D Drug utilization and repricing of services and medications. There are rules regarding which administrative costs may be paid from the MSA Account. In general, mailing costs, photo-copying charges, bank fees and income tax on the interest earned may be paid from the MSA Account. Administration and attorney fees may not be paid from the MSA Account. Detailed records of all expenditures must be kept and annual reporting must be made to Medicare.
Once the funds are exhausted, and if all funds can be shown to have been properly spent then Medicare will begin paying for injury-related care. If any funds are not spent correctly, then the injured worker will need to pay out-of-pocket until he/she can demonstrate they have properly spent the entire MSA Amount.
How do I comply with the banking requirements for Administration of my MSA Account?
Because the MSA Administration rules are so complex, CMS highly recommends Professional Administration. (Workers Compensation Medicare Set-aside (WCMSA) Reference Guide 3.7. Section 17.1.) A professional administrator has expert knowledge regarding Medicare’s rules and will process all bills in strict compliance with all regulations. The administrator will also keep all records and file all accounting with CMS.
Contact MSA Meds
If you didn’t receive settlement dollars to cover professional administration, there is no need for alarm. MSA Meds is able to offer FREE professional administration to our eligible pharmacy clients. Contact MSA Meds today to learn if you qualify. We do all the bill processing, record keeping and reporting so you can concentrate on getting better!