Workers’ compensation and payments

Posted by:  :  Category: Medicare

If you settle your workers’ compensation claim, you must use the settlement money to pay for related medical care before Medicare will begin again to pay for related care. In many cases, before a settlement is reached, the workers’ compensation agency asks Medicare to approve an amount to be set aside to pay for future medical care. Medicare will look at certain medical documentation and approve an amount of money from the settlement. This money must be used up first before Medicare starts to pay for related care that’s otherwise covered and reimbursable by Medicare.

Workers’ Compensation Medicare Set Aside Arrangements

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MSA Frequently Asked Questions

A WCMSA meets CMS’ criteria for review when: A.The Claimant is currently a Medicare beneficiary and the total settlement value is greater than $25,000. -or- B. The Claimant has a “reasonable expectation“ of Medicare enrollment within thirty (30) months of the settlement date and the anticipated total settlement amount for future medical expenses and disability/lost wages over the life or duration of the settlement agreement is expected to be greater than $250,000. Claimants have a “reasonable expectation” of enrollment where: (1) The claimant has applied for Social Security Disability Benefits. (2) The claimant has been denied Social Security Disability Benefits but anticipates appealing that decision. (3) The claimant is in the process of appealing a denial of or re-filing for Social Security Disability benefits. (4) The claimant is 62 years and 6 months old. (5) The claimant has an End-Stage Renal Disease (ESRD) condition but does not yet qualify for Medicare based upon ESRD. CMS has noted that while they do not wish to review WCMSAs if the thresholds are not met, these thresholds reflect a CMS operational workload standard only. They do not constitute a substantive dollar or “safe harbor” threshold. Medicare beneficiaries must still consider Medicare’s interests in all WC cases and ensure that Medicare is secondary payer to workers’ compensation. 5/11/11 Memorandum, Charlotte Benson, Acting Director, Financial Services Group. See also, WCMSA Reference Guide,
Source: the official U.S. government site for Medicare

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Contract Claims Services, Inc.

The amount of a Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) is determined on a case-by-case basis, and we take an aggressive approach to forecasting future costs, ensuring a solution that is both cost effective and gives adequate consideration to Medicare’s interests. CCSI is unique among our competitors, as we provide internal and legal specialists. Allocation reports are prepared by a Medicare Set-Aside Certified Consultant (MSCC) with over 18 years of experience with workers’ compensation claims.

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