Medicare Set-Asides

Solutions for Medicare Set-Aside Program   

MSA Services  What is a Medicare Set-Aside?

Medicare set-aside allocation is an agreement that takes place at claim settlement.  It prevents the shifting of burden for future injury-related medical expenses from the carrier to Medicare. 

What Is Involved In The MSA Allocation Process?

The medical records are reviewed and a determination is made as to what the future medical needs related to the injury are, and whether they are covered by Medicare. 

Using the information gathered, an amount for the set-aside is determined.  This amount could include money for: Durable Medical Equipment, Doctor Visits, and Prescription Medications. 

Our Professional Medicare Set-Aside Experts provide:

  • Comprehensive review of medical records.
  • Review medical payment history (for current Medicare recipients).
  • Outline physician recommendations.
  • Review pertinent standards of care.
  • Establish allocation amount.

 When Are You Required To Submit an MSA? 

Class I – The individual is a Medicare beneficiary at the time of settlement, regardless of the amount of the settlement. Class II – The individual is not a Medicare beneficiary at the time of settlement, but the following two-prong test is met: 

A. The total amount of the settlement is over $250,000. 

B. There is reasonable expectation of Medicare enrollment within 30 months of the settlement date. 

Consequences For Failing to Obtain an MSA?

Failure to protect Medicare’s interests may result in double damages being assessed against the party(s) responsible.  This could include the Insurance Company, the attorney and even the claimant. 

Who Completes The MSA?

Completing a Medicare set-aside allocation is a detailed process that requires the right tools.  This should be done by professionals such as those at Cost Containment Solutions who are experienced in the allocation process.  

Cost Containment Solutions Medicare Set-Aside Services     

Medicare Set-Aside Allocation Cost Projection completed and submitted for approval by Center for Medicare and Medicaid Services (CMS).  

  1. Required Release of Information forms obtained.
  2. Social Security and Medicare Status Determination.
  3. Medicare Set-Aside Allocation cost projection and recommendations.
  4. Life expectancy projection.
  5. Obtain approval of the adequacy of the MSA arrangement from (CMS).
  6. Perform Medicare conditional payment lien status verification.
  7. Rush Services (MSA allocation completed within 5 business days).
  8. Medicare conditional payment lien negotiation.
  9. Medicare conditional payment negotiations.
  10. Copy and Pick up files.
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