Medicare Set Aside

Medicare Set-Asides
In December 2003, President Bush signed the Medicare Prescription Drug Improvement and Modernization Act, which further defined Medicare’s recovery rights and clarified its enforcement powers.  As a result, the Centers for Medicare and Medicaid Services (CMS) has a right to seek recovery “against any entity, including a beneficiary, provider, supplier, physician, attorney, state agency or private insurer that has received any portion of a third-party payment directly or indirectly” if those third party funds should have covered injury-related medical expenses. This firm specializes in Medicare set aside assistance and filings in the South West U.S.A.

The population of beneficiaries that Medicare is intended to cover is on the rise: 54 million Americans are disabled and more than 41 million receive Medicare.  The plaintiff attorney and defendant can be held responsible for twice the amount owed to the agency.  CMS is not required to give notice so lawyers must proactively identify, verify and satisfy Medicare’s interest before distributing any settlement proceeds.  Medicare’s right to reimbursement is superior to almost all other claims, including those of the injured individual; hence the Medicare Set-Aside account was born.

The purpose of the MSA is to segregate funds to pay for all Medicare allowable services for a claimant’s related injury or disease that would otherwise be covered by Medicare.  It ensures that your medical expenses are covered and that your future Medicare eligibility is safeguarded.

The CMS guidelines/eligibility for CMS are as follows:

–  The claimant is currently a Medicare beneficiary and the total settlement amount is greater than $25,000

–  The claimant has a “reasonable expectation” of Medicare enrollment within 30 months of the settlement date and the settlement is greater than $250,000.

MSAs are established according to 42 CFR Section 411.46 known as the “Medicare Secondary Payer Act.”  The Act requires future medical expenses to be paid primarily through settlement funds.  Medicare can be billed directly for expenses occurring after the MSA funds are dissipated.

We Can Help!

We partner with resources and all interested parties prior to settlement to ensure the MSA and all related documentation meet the rigid CMS submission requirements.