When an individual is using Medicare for medical and therapeutic expenses that result from an injury, Medicare tries to ensure that it does not pay for services that could be covered by funds the individual has already received elsewhere that were specifically meant to be used for care required as a result of that injury. Therefore, the Centers for Medicaid and Medicare Services (CMS) require that an account be established in which a portion of the monies from the settlement or award is to be placed to cover future medical expenses incurred as a result of the injury. Medicare Set-Aside (MSA) refers to this portion of the settlement or award that must be spent on injury-related medical expenses before Medicare becomes available to cover any additional injury-related medical expenses beyond the MSA Allocation. Cases in which an MSA will be requested may include Workers’ Compensation cases or cases in which automobile insurance policies, general liability insurance policies, or no-fault insurance plans would be expected to compensate the individuals for expenses incurred as a result of an injury.
The production of the MSA Allocation is complex and challenging. Comprehensive Rehabilitation Consultants is prepared for the demanding task of evaluating and projecting funding requirements for ill or injured clients.
- Verify Medicare & Social Security status to determine the eligibility of the client for MSA
- Project MSA allocation to provide medical cost analysis
- Prepare the MSA Allocation
- Submit the MSA to the Center for Medicare Services for review and continuing contact until approved
- Act as MSA Administrator (includes annual accounting report and summary of expenditures)
- All services are offered individually or as a comprehensive package
For more information, please contact the Case Management department.