Medicare Set Aside

Examining Medicare Set Aside Allocations

Medicare Set Aside allocation is currently required in the settlement of Workers’ Compensation cases, and may be required for liability settlements to determine future care expenses related to the injury. Once the report is prepared it is submitted to Medicare for approval.

Once approved, the appropriate funds are then “set-aside” and used for Medicare-covered treatment. A detailed Medicare Set Aside allocation requires a professional who’s knowledgable and keeps current on Medicare policies.

Our Methodology Includes: Records Review

At QRCS our nursing consultants review medical records from the past two years and prepare a precise timeline. This narrative provides an organized outline of the nature of the injury and related medical care.

Research

Our professionals research standards of care and evidence-based practices to accurately project necessary future medical care needs related to injury, while also providing costs associated with the anticipated care based on Medicare guidelines.

This care often includes follow-up physician visits, therapies, diagnostic testing, and prescription medications. We provide you with the necessary items that pertain to Medicare’s approval.

Qualification

At QRCS, our professionals are certified Medicare Set-Aside Consultants with over seven years experience in preparing Medicare Set Aside allocation reports.

Let’s Take Time To Examine Medicare Set Aside Allocation Closer.

Why Is Medicare Involved In Your Settlement?

By Federal law, Medicare is always a “secondary payer” which means if there is any other insurance available – for example from a workers’ compensation or a personal-injury suit – Medicare will not pay bills for your injury unless that insurance becomes unavailable.

Since you received settlement money from an insurance company to cover your future medical treatments, Medicare wants to make sure that you spend that portion of your settlement money on injury related care, before the taxpayers start paying for your injury through Medicare.

What Is A Medicare Set-Aside Allocation?

The way Medicare ensures that it does not pay bills for your injury until your settlement funds are spent is through a Medicare Set-aside Allocation (MSA). An MSA is a projection of the cost of the future treatment for your injury including doctor’s visits, tests, surgical procedures, and medications.

The MSA amount, as set forth in the CMS determination and settlement documents, must be then be placed into a Medicare Set-aside account and spent on treatment for your injury.

Medicare Set Aside Allocation Guidelines

There are different guidelines for Medicare Set-aside Allocations depending on your type of case:

Workers’ Compensation Medicare Set-Aside Allocations (WCMSA) and
Liability Medicare Set-Aside Allocations (LMSA)