Verification of the injured person’s Social Security and Medicare status through their local social security office.
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MEDICARE SET-ASIDE ALLOCATION (MSA) REPORTS
Medivest recognizes the important role we play in the settlement of workers’ compensation and personal injury claims and how imperative it is to understand and assist settling parties with Medicare Secondary Payer (MSP) compliance. A Medicare Set-Aside Allocation (MSA) Report is one of the first steps taken in an effort to consider Medicare’s future interest. Medivest has an outstanding record for providing accurate and timely MSA allocations that allow the settling parties to confidently proceed forward with their settlement.
What Is a MSA Report?
A Medicare Set-Aside Allocation Report is a detailed report indicating what the anticipated Medicare allowable, injury-related expenses will be for the remainder of the injured individual’s life expectancy. In other words, Medicare set-asides are a portion of the settlement funds that are “set aside” to pay for the Medicare covered injury related future medical treatment.
The types of settlements that are eligible for a MSA report include those arising from liability and workers’ compensation claims. For workers’ compensation awards, many call the report a WCMSA. For a liability settlement, it is called a LMSA.
The LMSA and WCMSA reports provide the settling parties with a dollar amount that should be “set aside” out of the settlement to satisfy Medicare’s future interests. These reports are a detailed analysis based on an individual’s injuries, anticipated treatment and life expectancy.
When using set-asides, the funds go into a particular type of account held for payments as needed. Each year, the administrator provides detailed accounting to Medicare about the expenses paid on the beneficiary’s behalf. Before Medicare covers injury related treatment, the beneficiary must exhaust all set-aside funds.
Every Medicare Set-Aside Allocation Report produced by Medivest is written by a highly trained nurse that possesses a wealth of knowledge and experience in the preparation of these reports. We also have certified coders who review every allocation with the most up-to-date coding and pricing available.
When Should You Consider a MSA Report?
Preparing a LMSA or WCMSA is ideal when settlement or treatment costs exceed a specific amount and any of the following apply:
- If the injured individual is receiving Social Security Disability or Retirement
- If the injured individual is eligible or receiving Medicare
- If the injured individual is age-eligible or within 30 months of becoming a Medicare beneficiary
How Long Does a Medicare Set-Aside Take to Prepare?
Many factors influence how long a LMSA or a WCMSA takes to prepare and earn approval from the Centers for Medicare and Medicaid Services (CMS).
Circumstances that impact report preparation timing include:
- Case details: More complex cases generally require additional analysis time.
- Severity of injuries: The more serious an injury is, the longer the scope and duration of treatment to consider in the report.
- Amount of medical records to gather: Time spent collecting and analyzing records grows with the number of treatments and providers involved.
Experienced Medicare set-aside companies like Medivest can generally create an analysis within ten business days or less.
Getting a CMS approved MSA takes about 30 to 60 days on average.
Other Services Related to Medicare Set-Aside Allocation Reports:
SOCIAL SECURITY AND MEDICARE ELIGIBILITY
REQUEST AND VERIFY CONDITIONAL PAYMENT
Determination if Medicare has any outstanding conditional payments, or liens, that will need to be reimbursed at time of settlement and help to determine if there are any inconsistencies in the Conditional Payment Letter (CPL).
NON-QUALIFIED REPORT
A detailed report of all the Non-Medicare covered items that are injury related
These services prove to be invaluable to the settling parties and provide a clear indication of the steps necessary to successfully protect Medicare’s interests in a settlement, as well as to help the settling parties value the medical portion of the case.
We pride ourselves on maintaining the highest level of customer service, from our Medicare Set-Aside Allocation Report turnaround time to always making sure we are available by phone or email. Our goal is to make sure that our clients’ needs are met and that expectations are continuously exceeded. No matter where you are in the settlement process, Medivest will continue to work tirelessly to make sure that our clients’ needs are managed and held to the highest standards of quality.
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