What You Need to Know About a Potential Review Process for LMSAs

Up to this point, there have not been any formal policies put in place by the Centers for Medicare and Medicaid Services (CMS) in regards to Liability Medicare Set-Asides (LMSA). Instead, two memos, Stalcup and CMS HQ, offer guidance on how the organization would like all entities to approach Medicare set asides (MSA). However, indicators began last summer that a change may be in the works, starting with an alert from CMS indicating that they were taking into consideration the creation of a voluntary process for reviewing liability MSAs. The process would review No-Fault MSAs as well.

Other Indicators of a Review Process for LMSAs

Since that time there have been several more indicators that the establishment of a review process is imminent. These include:

  • This past December, CMS released a Request for Proposal (RFP) for their Workers’ Compensation MSA contractor. It has been indicated that the contractor would also review LMSAs, breaking them down into two categories based on the settlement. These categories are full reviews and cursory reviews and are slated to start in July of 2018
  • According to documentation by CMS, LMSAs and NFMSA will have notated fields on the agency’s Common Work File. Additionally, request for payment for services will be denied if beneficiaries have open LMSA or NFMSA records.

Potential Impact

According to CMS, under this policy, up to 11,000 cases will require a full review, while 40,000 cases will need a cursory review. Generally speaking, it’s critical to make sure that you and your clients keep Medicare in mind when it comes to settlements and the future medical expenses that liability MSAs are used for.

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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"I recently engaged Synergy to assist with a complicated PTD settlement involving a substantial Medicare Set Aside. The claimant’s wife has been providing full time attendant care which is not Medicare covered. The Synergy nurse was able to do a full analysis of non-Medicare covered expenses which far exceeded the value of the MSA analysis performed by the carrier’s contracted MSA provider. The non- Medicare figures became the main focus of the settlement negotiations and more than doubled the value of the case. Although I could estimate the attendant care figures, the nurse added in other items that I would not have routinely considered. I also asked Synergy to evaluate the EC’s MSA as well as their prescription review. Synergy offered insight about the prescription donut hole which I did not have a clear understanding about. Again, their insight and information added a great deal of value to the overall settlement. Not only did I learn from Synergy but was able to educate my clients in the process. These are very complex and complicated areas; I will use Synergy again and again!"

Rosemary Eure
Lancaster & Eure

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