WCMSA – Workers Compensation Medicare Set-Aside

If you want to avoid delaying a client’s settlement and noncompliance with federal law, let Synergy Settlement Solutions assist you with proper settlement planning and preserving your client’s benefits through a workers compensation medicare set aside (WCMSA) arrangement.

Medicare Secondary Payer (MSP)

If you are representing a client in a workers’ compensation settlement who is also a Medicare recipient, both you and your client are responsible for abiding by Medicare Secondary Payer (MSP) laws. In a workers’ compensation settlement, Medicare is considered a secondary payer. This means that by law, a Medicare beneficiary is required to apply for workers’ compensation benefits to pay for work-related injury medical expenses before Medicare will pay for any treatments.

What is Workers’ Compensation Medicare Set-Aside Arrangement?

Whenever you are handling a case that involves Medicare and the settlement of a case involving future medical expenses, you must ensure that the interests of Medicare are protected in the process. According to MSP laws, a workers compensation MSA is sufficient solution for doing so.

The purpose of a WCMSA is to preserve future Medicare benefits. It is an agreement where a portion of a client’s workers’ compensation settlement is allocated to pay for future medical expenses related to the client’s case. After the settlement funds have been depleted, Medicare will begin paying (with respect to payment stipulations) for the client’s injury-related treatments. It’s important to note that the amount of the WCMSA is determined on a case-by-case basis and reviewed by the Centers for Medicare and Medicaid Services (CMS).

Is a CMS Review Required?

A workers compensation MSA proposal does not have to be submitted for review to the CMS; however, it is highly recommended. If you choose to submit to CMS for review, the claimant must either be a Medicare beneficiary with a settlement greater than $25,000; or have a reasonable expectation of Medicare enrollment within 30 months of their settlement with a total settlement that exceeds $250,000. The CMS has a set of criteria to determine if the amount allocated for future medical expenses is reasonable.

Why Partner With Synergy Settlement Solutions?

As an attorney, you should know that there are ethical and legal obligations connected to protecting the interests of Medicare in a workers’ compensation case. Failing to do so can lead to legal actions against you. No longer do you have to go through many companies to meet MSP compliance and secure a WCMSA, our highly skilled consultants provide a range of settlement service solutions to make the entire process easy for you.

For more information or to schedule a consultation, please submit our contact request form or call (877) 242-0022.

Disclaimer: The information contained in this article is for general educational information only. This information does not constitute legal advice, is not intended to constitute legal advice, nor should it be relied upon as legal advice for your specific factual pattern or situation.


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