Provider Resources
As a healthcare provider or medical billing professional, you may occasionally come across patients whose care is linked to a workers’ compensation or liability settlement. In these cases, Medicare requires special handling of future medical costs related to the injury or condition. This is where a Medicare Set-Aside Account comes into play.
What is a Medicare Set-Aside (MSA) Account?
When a patient has an injury settlement, a portion of the settlement funds is set aside to pay for future Medicare-covered medical care and devices related to the covered injury. The MSA account follows the Medicare Secondary Payer (MSP) statute, which states Medicare should be the secondary payer for injury-related care that it would typically cover.
What is Medivest’s role?
Medivest has been hired as the Professional Administrator to manage the patient’s MSA account. As an administrator, Medivest’s duties include:
- Protecting Medicare entitlement by ensuring compliance with Medicare regulations.
- Ensuring that MSA funds are properly spent in accordance with CMS’ regulations.
- Coordinating benefits with doctors, pharmacists, and medical equipment vendors to ensure proper billing and payment of goods and services.
- Corresponding with providers and CMS/Medicare on behalf of the member.
- Maintaining a record of payments from the MSA account and submitting the annual attestation to CMS, when applicable.
- Educating members, guardians, and providers regarding MSP compliance.
How to Accept Payment From a Medivest MSA
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- The injured party shows their Medivest Member ID Card to their doctor when they seek treatment, or to their pharmacist when they fill their prescriptions.
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- Their doctor or pharmacist will contact Medivest to verify benefits, just as they would with any other major medical insurance provider.
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- The injured party’s billing notices are then sent directly to Medivest for processing.
No co-pays, deductibles or out-of-pocket expenses should be charged for injury-related treatment.
For eligibility, coverage, or claim status, contact
Customer Service at 877.725.2467
Monday – Friday 8 am to 5 pm EST
Claims submittal: claims@medivest.com
Fax: 407.971.4742
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