Medicare Set Aside (MSA)

A Medicare Set-Aside is an arrangement between the settling parties and by law must protect Medicare’s interests when settling future medical benefits for qualified individuals and prevent the shift of burden from the primary payer to Medicare.

All our MSA reports are evidenced-based and are defensible in court.

MSA Settlements has partnered with Fluent Systems to provide a proprietary state of the art database system for our Medicare Set-Aside clients. The database is available for both Basic MSA’s and Complex MSA’s, with compliant and appropriate submissions to CMS. Reports are designed and produced to take the “Argue” out of the MSA part of the settlement process, to make the submissions process more efficient, less costly, and more surely compliant, and to guard the potential liability issues of the client.

All Reports we produce for you include and detail the doctor’s notes and treatment plans to ensure compliance with and acceptance by CMS. Allocations will be broken out by Anticipated Medicare Costs and Anticipated Non-Medicare Costs. Each of the reports will be categorized to assist with settlement and ease of litigation. All reports will be prepared by experienced MSCC Certified staff and reviewed as necessary by Senior Staff with decades of experience writing reports.

Liability MSA’s (LMSA)

In preparation for liability, personal injury, or no-fault cases Report, we recommend including design factors] considering Medicare’s interest. There are mounting indications that CMS will establish formal guidelines for liability settlements in the near future. Prudence implores that protecting Medicare’s interest is necessary for any settlement involving a Medicare beneficiary. Our highly experienced Medicare Set Aside Certified Consultants and Registered Nurses address regulatory and medical aspects of the MSA. We identify and implement cost-saving solutions to the MSA. Our systems and technology identify and suggest efficient cost-saving solutions for the MSA’s. MSA SETTLEMENTS Reports utilize accepted rated ages and structured settlements to produce best evidence analytics and conclusions.

Pursuant to 42 U.S.C. §1395y (b) (2) (A) (ii), CMS/Medicare is the secondary payer in all worker’s compensation, no-fault and general liability claims. Under the Medicare Secondary Payer Act (MSP), CMS has taken the position that they are the secondary payer regardless of liability and they have a statutory right of recovery against all parties, including law firms involved in the claim, related to their past interests and/or future interests.

Prior to 2011, CMS policy memorandum were directed at workers’ compensation plans. In May 2011, Sally Stalcup, CMS’s Region VI (Dallas) MSP Regional Coordinator issued a general memorandum regarding Liability Medicare Set-Asides (LMSA’s). In this memorandum, it was noted that “Medicare’s interests must be protected; however, CMS does not mandate a specific mechanism to protect those interests. The law does not require a ‘set-aside’ in any situation. The law requires that the Medicare Trust Funds be protected from payment for future services whether it is a Workers’ Compensation or Liability case. There is no distinction in the law.”

The memorandum was followed on September 30, 2011, by a statement regarding MSA’s in non-workers’ compensation case by Charlotte Benson of CMS/Office of Financial Management.

Cases where Medicare’s Interest should be considered in Liability claims

• Cases where future medical expenses are being considered in the settlement;
• Cases involving a Medicare beneficiary or someone who will be entitled to Medicare in the foreseeable future;
• Catastrophic injury cases such as traumatic brain or spinal cord injuries, multiple amputations or cases involving severe psychological components. Long-term medical care and treatment will be presumed by CMS as necessary in these cases;
• Structured settlements: Medicare generally takes notice of these settlements given that long-term care may be part of the settlement agreement; and
• Any case in which the injured person will certainly require future medical care and treatment for the injury, exposure or ingestion.