LIABILITY MEDICARE SET-ASIDE ALLOCATION (LMSA) 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 Liability Medicare Set-Aside Allocation (LMSA) 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 LMSA allocations that allow the settling parties to confidently proceed forward with their settlement.
What Is a LMSA Report?
A Liability Medicare Set-Aside (LMSA) refers to a financial arrangement that is established in certain legal cases involving Medicare beneficiaries who have or may have future Medicare entitlements. It is specifically related to cases where a liability insurance settlement, judgment, or award is made to a Medicare beneficiary to cover future medical expenses.
The purpose of an LMSA is to “set aside” a portion of the settlement funds to cover the Medicare beneficiary’s future medical expenses that would typically be covered by Medicare. These funds are held separately and are intended to be used solely for Medicare-eligible expenses related to the injury or illness for which the settlement was awarded.
The establishment of an LMSA helps ensure that Medicare is not billed for expenses that should be covered by the settlement. It assists in protecting the Medicare program’s interests by preventing the inappropriate use of Medicare funds.
Every Liability 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 LMSA Report?
A Liability Medicare Set-Aside (LMSA) may be needed in cases where a Medicare beneficiary is involved in a legal claim or lawsuit that results in a settlement, judgment, or award for future medical expenses. Here are some situations where an LMSA may be necessary:
- Personal Injury Claims: If a Medicare beneficiary is injured due to the negligence or fault of another party, and they pursue a personal injury claim or lawsuit, a LMSA might be required. This typically applies to cases such as car accidents, slip and falls, medical malpractice, or product liability where the injured party is eligible for Medicare.
- Product Liability Claims: If a Medicare beneficiary suffers harm or injury due to a defective product and seeks compensation through a product liability claim, a LMSA might be necessary. It helps ensure that the funds obtained from the settlement or judgment cover future medical expenses rather than relying on Medicare.
- Workers’ Compensation Claims: In situations where a Medicare beneficiary is injured on the job and files a workers’ compensation claim, a Workers’ Compensation Medicare Set-Aside is typically prepared. However in some instances, a LMSA may be needed. This ensures that the future medical expenses related to the workplace injury are covered by the settlement or award, rather than shifting the burden to Medicare.
How Long Does a Liability Medicare Set-Aside Take to Prepare?
Many factors influence how long a LMSA 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.
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October 7, 2024
