February 19, 2019
In workers’ compensation, Medicare Set-Aside (MSA) compliance is crucial to proactively managing claims and mitigating the risk of potential settlement costs.
According to the Centers for Medicare and Medicaid Services (CMS), all parties in a workers’ compensation case have significant responsibilities under the Medicare Secondary Payer (MSP) laws to protect Medicare’s interests in cases that involve future medical expenses. CMS recommends using an MSA agreement to allocate a portion of the workers’ compensation settlement for future medical expenses related to the workplace injury, illness, or disease.
CMS’ recently updated reference guide highlights the potential consequences of not including a Medicare Set-Aside, or similar medical cost projection, in a workers’ compensation settlement. CMS emphasized that settling claims below review threshold amounts must still protect Medicare’s interests. The Reference Guide release also details CMS inclusion of certain medications, including Lyrica and Trazodone, in the MSA.
Though CMS’ MSA review is voluntary, it is the only option to assure finality of future medical payment responsibilities, as CMS states they stand behind the MSA amount they approve. Settlements without a CMS-approved MSA may be subject to future reimbursement demands – which can reach as high as the total settlement value. Because of this, comprehensive MSA allocation reports are essential to mitigating risk of these demands.
At CorVel, our certified Medicare Consultants provide expertise in developing comprehensive MSA reports that meet Medicare Secondary Payer requirements and provide the injured worker with the necessary coverage through life expectancy. Our MSA services demonstrate a solid plan for future medical care and protection of Medicare interests following the settlement.
CorVel is an experienced leader in the MSP industry providing MSA services since 2001. Our Medicare Consultants provide expertise guidance in all areas of MSP compliance.
Learn more about our Medicare services here.