Recently, the Centers for Medicare & Medicaid Services (CMS) stated that they endorse the use of professional administration of Medicare Set-Aside (MSA) accounts. Specifically, CMS added the following to their WCMSA Reference Guide: “Although beneficiaries may act as their own administrators, it is highly recommended that settlement recipients consider the use of a professional administrator for their funds.”
“We’re not surprised by CMS’ recommendation,” says Douglas M. Brand, CEO of Medivest, a national leader in Professional Administration. “The WCMSA Reference Guide says time and again that MSA funds have to be ‘appropriately exhausted’ before Medicare will accept responsibility for injury related expenses. Administering a MSA properly is an almost impossible task for most. For CMS to use the phrase ‘highly recommended’ means they recognize the challenge and want the MSA beneficiary to get help."
Professional administration of MSA’s has been a staple of structured settlement cases for some time. Injury victims can often benefit from having the assistance of an experienced custodian to properly track expenses and provide accounting to CMS. Having a professional administrator for a MSA account is part of securing the financial future and care of injury victims and their families. If the beneficiary of MSA funds doesn’t properly account for expenses, their entire Medicare entitlement could be jeopardized.
A professional administrator will:
- Explain covered (and not covered) benefits to the claimant;
- Work with the health care provider on billing issues;
- Complete all accounting functions for the MSA; and,
- Interface with CMS to ensure that Medicare accepts role as primary payer of the MSA account exhausts.