Preparing the Medicare Set-Aside Arrangement and allocating settlement funds is a good start to protecting Medicare’s interests, but the real work comes with managing the funds appropriately. There are strict guidelines for this process and unwanted fines if they are not followed. Through professional administration, this burden can be handled by an expert. Don't risk any undesired penalty payments. Call us today for help with professional administration!
Guidelines and Penalties
Following Medicare’s current guidelines in its 31 page “Self-Administration Toolkit for Workers’ Compensation Medicare Set-Aside Arrangements (WCMSAs)” and the 134 page “Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide”, as well as any subsequent policy changes, is a daunting task and should not be taken lightly. There are painful penalties for failure to manage, spend and account for these funds.
MSA funds must be deposited into an interest-bearing account and not comingled with other funds.
The funds can only be spent for treatments related to the covered injury and only for Medicare eligible treatments. Paying for the medical treatment at the proper rate is also a requirement. This can be according to a fee schedule, a ‘usual & customary’ billing rate or at a “Fair Market Price”, which is a rate generally accepted as full and final payment by medical providers for the covered treatment.
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The Centers for Medicare & Medicaid Services (CMS) requires that an accounting be prepared and submitted annually to show that the funds in the MSA are being properly administered and the details of these expenditures must be maintained until the funds are finally exhausted or the fund is terminated and a final accounting is made to CMS.
The complications of staying within the boundaries of this complex and confusing maze of guidelines, policies and rules is well beyond the ability of most laymen and should be addressed with the same level of importance as the preceding steps in the settlement process. These responsibilities can be handled through professional administration at a reasonable cost with the effect being peace of mind for all involved. Further, through careful management, the likelihood that the funds allocated to the MSA will be sufficient for the long run are greatly enhanced.
So contact us today for help with professional administration!