Medicare Set-Aside Allocation

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Medicare Set-Aside Allocation

Medicare set-aside allocation is an agreement that takes place at claim settlement. It prevents the shifting of burden for future injury-related medical expenses from the carrier to Medicare.

If a determination is made that an Employer or Workers' Compensation Carrier attempted to shift the burden for payment of medical expenses for an injured employee to Medicare, Medicare can make a claim against the employer and/or insurance company for reimbursement.

A Medicare Set-Aside Allocation and approval by the CMS (Center for Medicare and Medicaid Services) is required with any settlement in which:

The claimant is a Medicare recipient at the time of settlement regardless of the amount of the settlement.
The claimant is not yet receiving Medicare benefits but the following 2-prong test is met:
a) The total amount of the settlement (indemnity plus medical less attorney fees) is over $250,000.00, and
b) It is reasonably expected that the claimant will becomed a Medicare recipient within 30 months of the settlement.

Any monies placed into a Medicare Set-Aside trust or custodial account will be paid out according to the workers' compensation fee schedule. However, only Medicare covered expenses will be paid from these funds once the claimant becomes eligible for Medicare benefits (i.e., prescription medications and attendant care are two of the items which cannot be paid from the MSA funds).

Commonwealth Vocational Consultants' specialized team of disability management consultants and Medicare billing specialists thoroughly review and evaluate files and prepare comprehensive written reports.

Features

Determine Social Security Disability and Medicare status
Evaluate need for set-aside and CMS approval
Determine Medicare allocation over life expectancy, considering rated age when obtained
Determine Medicare lien status and lien negotiation
Submit allocation to the Center for Medicare and Medicaid Services for approval, when requested

For additional information, contact us at info@cvocc.com or (859) 514-0356.