We have entered into an era where The Centers for Medicare & Medicaid Services (CMS) has unprecedented access to settlement data involving Medicare beneficiaries and those close to becoming beneficiaries. It is now more important than ever to ensure Medicare’s future interests are protected when you settle your workers’ compensation case. Read on and contact our team to learn more about why you should use a professional administrator for your Medicare set-aside funds.
Do you need a professional administrator for your Medicare set-aside funds?
In an effort to protect its long-term financial stability, Medicare requires that in certain circumstances, a portion of the injured worker’s settlement be set aside in a Medicare Set-Aside (MSA) account. But what is an MSA? In a nutshell, an MSA is Medicare’s way of making sure the injured worker does not “double dip” after receiving future medical damages in a settlement. Basically, Medicare wants to avoid a situation where the injured worker receives funds to cover future medical care, but then seeks to have Medicare pay for that same future injury-related care. The MSA functions as a substitute for Medicare coverage for injury-related medical care.
So, your attorney informs you that a portion of the settlement must be set-aside in an MSA. But really, why can’t injured workers simply handle taking care of MSA themselves? Well, the simple answer is this – The Centers for Medicare & Medicaid Services (CMS) highly recommends using a professional administrator to manage your Medicare Set-Aside (MSA) funds and account. A professional administrator can help take the burden off the injured worker when it comes to managing the funds, tracking the funds and filing the required reports with CMS.
Back in 2017, CMS updated their reference guide for Workers’ Compensation Medicare Set-Asides (WCMSA) and included a section providing that “It is highly recommended that settlement recipients consider the use of a professional administrator for their funds.” Professional administration is recommended because there are many rules and regulations that govern the administration of a Medicare Set-Aside account and it is very easy for an injured worker to risk their Medicare benefits by mismanaging the account.
What are the benefits of a professional administrator for your Medicare set-aside funds?
So how hard can it be? Well, injured workers are only allowed to spend their MSA funds on Medicare-covered treatments that are related to their accepted injuries. This often requires securing documentation from Medical Providers and complicated research of Medicare coverage issues.
In addition, the MSA funds must be placed in a separate, interest-bearing bank account. The injured worker must keep copies of all bills and receipts. The injured worker must report all expenses they used their MSA funds on to CMS each year in what is called an annual attestation and should the MSA funds run out, the injured worker must file a temporary depletion form or a permanent exhaustion form with CMS if they are permanently out of money. The injured worker must only pay bills according to the fee schedule or pricing approved by Medicare, which may be difficult to calculate or secure from your medical provider. If the injured worker pays above the approved price, they could potentially have to repay Medicare for the cost of the treatment that was above the approved price amount. Oh, and you must do all this while you are recovering from your injuries.
On top of all that, failure to file the required reports with CMS and/or use the MSA funds properly may very well result in Medicare denying payment for treatments that are related to the injury, thereby putting your Medicare benefits at risk.
So, the advantage of using a professional administrator is that all this work can be done for the injured worker and not by the injured worker. The MSA funds are deposited into an interest-bearing account at a bank and the administrator handles all the medical documentation, research, administration, payment and reporting so that the worker can focus on their treatment.
Contact MSA Meds
MSA Meds stands ready to assist the injured worker with their MSA funds and take on the burden of dealing with the paperwork and payment of invoices so that the worker can focus on the important task of recovering from their injuries. Moreover, through our affiliated pharmacy, we can ensure the prompt and secure delivery of all your injury-related medication, giving you even less to worry about while you are recovering. Best of all, our service is free to eligible pharmacy clients. Contact us today to see if you qualify to participate in our FREE Professional Administration Program. Contact MSA Meds today.