Shay Jacobson, RN, MA, NMG, LNCC, CNLCP
It has been said that one should never cross the IRS.
It’s also not a good idea to overlook the interests of Medicare.
The Centers for Medicare and Medicaid (CMS) operate under Federal Statutes. The statutes dictate that in workers’ compensation and liability litigation cases, Medicare’s interest must always be considered. Cases settling at review threshold levels are subject to Federal scrutiny for compliance.
If Medicare’s interests are not properly considered when a large Workers’ Compensation settlement is awarded, Medicare may deny future claim-related benefits.
In sum, an injured party must reserve a portion of his or her workplace/liability injury-related settlement for future medical expenses. If the injured party sustains qualified medical expenses that deplete the reserved sum, Medicare will pay for allowable expenses in excess of the properly expended MSA funds.
MSA: Medicare Set Aside
In Workers’ Compensation and liability cases, Medicare requires what is known as a Medicare Set Aside. A Medicare Set Aside is essentially a portion of the settlement that is purposefully set aside to ensure that the injured party’s qualified medical expenses are funded privately, at least until such time as this set-aside fund is exhausted. This, under the federal statute, represents consideration of Medicare’s interests.
Determination of the need for an MSA, and the specific amount that should be set aside to adequately protect Medicare’s interests, is a bit of an art. It is so artful, in fact, that those who make these determinations must be Certified as Medicare Set-Aside Consultants.
Lifecare Innovations now has a team of licensed clinical social workers who have recently received this certification and are actively consulting on Medicare Set Aside cases.
Third Party Administration
Once the Medicare Set-Aside figure has been established and the funds set aside, it is wise to have those funds under the stewardship of someone other than the plaintiff. The injured party may well understand that those funds are to be conserved for the payment of care-related expenses, but may or may not use good judgment in the manner in which those funds are ultimately expended.
Third-party administration (also known as TPA) allows for a licensed administrator to hold those funds and make decisions with respect to the manner in which they are used. As a licensed third party administrator, Lifecare Innovations now serves in this role, as well, and can also review medical bills, negotiate with care providers, and pay bills.