A colleague recently asked me what happens to the funds placed in an established Medicare Set-Aside when the injured employee/beneficiary dies before the funds are completely exhausted. Since my legal responsibility usually ends once an MSA is established I did not readily know the answer to this question and I had to dig through old policy memorandums issued by the Centers for Medicare and Medicaid Services (CMS) to find the answer. According to the policy memorandum issued on April 22, 2003, (more…)
Medicare Set-Aside
Acronyms and Definitions
§ – Section
CAT claim – Catastrophic designation (designation through the SBWC)
CAT scan, CT or CT scan – Computed Tomography (medical procedure)
CMS – Centers for Medicare & Medicaid Services
FCE – Functional Capacity Evaluation
Depo – Deposition
IME – Independent Medical Examination
MMI – Maximum Medical Improvement
MRI – Magnetic Resonance Imaging
MSA – Medicare Set-Aside
O.C.G.A. – Official Code of Georgia Annotated
PPD – Permanent Partial Disability
PT – Physical Therapy
SITF – Subsequent Injury Trust Fund
TPD – Temporary Partial Disability
TTD – Temporary Total Disability
WC or Workers Comp – Workers’ Compensation
WCMSA – Workers’ Compensation Medicare Set-Aside
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Workers’ Compensation Settlement and Medicare Set-Asides
Developing a Medicare Set-Aside makes it easy for insurers to consider Medicare’s interests during workers’ compensation negotiations. Federal law requires that employers, group health plans, and insurance companies, consider the Centers for Medicare and Medicaid Services’ (CMS) interests during the settlement of workers’ compensation claims. There are several ways the parties may consider CMS’s interests (more…)
Violating the Medicare Secondary Payer Act Can Hurt Insurers’ Bottom Line
Not accounting for Medicare’s interest during workers’ compensation settlements can lead to shortfalls in insurers’ bank accounts. Under the Medicare Secondary Payer Act (MSP), the Center for Medicare and Medicaid Services (CMS) has the right to seek reimbursement of medical expenses paid by Medicare, which the workers’ compensation carrier should have made. [1] The Act requires that insurers consider Medicare’s interest during claim settlement and reimburse the Center for expenses paid towards treatment of the Medicare beneficiary’s work related injury. Participants in a settlement who fail to adhere to the Act’s rules may find themselves accosted with fines and significant liens. Developing a Medicare Set-Aside allocation can protect the parties from these fines. It also gives the parties a realistic projection of the claimant’s future medical cost and provides the opportunity to base settlement negotiations on this number.
[1] 42 U.S.C. §1395y (b)(2)(B)(i)(ii)(iii)
