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What Is A Medicare Set-Aside Allocation?

Complete Guide to MSP Compliance

Medicare Set-Aside Blog on April 8, 2006 | Posted by

Under the Medicare Secondary Payer statute, parties to an insurance settlement involving Medicare beneficiaries are responsible for protecting Medicare’s financial interests. Although legislation was enacted in 1980, the Centers for Medicare and Medicaid Services (CMS) did not begin enforcing the provision until 20 years later. In 2001, CMS published the first of many memos to help guide people in the field on how to best prepare a Medicare Set-Aside allocation (MSA). Essentially, an MSA is a tool used in settlements to determine what amount, if any, is appropriate to “set aside” for future Medicare-covered medical expenses related to an injury. Although the statute applies to workers’ compensation, no fault, and liability claims, enforcement thus far has been limited to workers’ compensation settlements. An MSA is prepared by reviewing a claimant’s medical background and treatment specific to an illness or injury for which the carrier is obligated to pay. Based on past

treatment and treating physician recommendations, an MSA is designed to include all reasonably anticipated costs that could fall on Medicare’s shoulders. Hence, once an MSA has been prepared and includes all necessary legal terminology and settlement language, it is submitted to Medicare for approval. After all settlement documents have been received and an MSA is approved, that money is set aside in a trust and limited to use for Medicare-covered treatment for that particular injury. Therefore, in order to present a comprehensive MSA and protect the interests of all parties involved, it is imperative to keep up with changes in Medicare policy, Medicare coverage, and other industry news. For more questions about Medicare Set-Aside allocations or the other services available to adequately settle a case, contact MEDVAL or subscribe to this blog for regular updates.

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