What You Should Know About Medicare Set Asides in Liability Cases

After securing your client’s settlement, your work is not done. If Medicare paid for any of your client’s medical expenses, you should be careful to prioritize Medicare’s interest and take care of any liens before disbursing settlement funds. The Centers for Medicare and Medicaid Services (CMS) has issued no formal statutes, regulations, or guidelines regarding liability settlements for Medicare Set Aside (MSA) or Liability Medicare Set Aside (LMSA).

Medicare Set Asides in Liability Settlements Continue to Evolve

According to CMS, Medicare recipients involved in liability and no-fault legal cases should consider an MSA account if they anticipate needing long-term care for their injuries. Additionally, CMS was scheduled to stop paying for health care services that other parties should be responsible for pursuant to liability and no-fault insurance cases, making the Medicare administrative contractor responsible for tracking liability MSAs related to a claim. If LMSAs are found, payment for items and services were to be denied and paid from the LMSA instead.

Protecting Medicare’s Interest Is Critical

An MSA is not a requirement under Medicare Secondary Payer provisions. However, Medicare is paying attention to post medical settlements to ensure compliance with the Medicare Secondary Payer Act. It is highly recommended that attorneys ensure that their clients protect Medicare’s interest when the liability case settles. There is no new mandate for Medicare beneficiaries to establish a LMSA if the treating physician attests in writing (physician’s letterhead) that no Medicare covered treatment related to the accident is needed for your client in the future. A physician only needs to provide on letterhead a statement indicating that no future treatment is required for accident-related care. On the other hand, if your Medicare eligible client’s settlement includes money for future medical services, an LMSA is recommended.

Meeting Your Client’s MSA Needs

Liability settlements will need to be dealt with on a case-by-case basis. In the meantime, seeking the assistance of a knowledgeable MSA expert and continuously monitoring CMS.gov for updates is advised. At Synergy, we work diligently to ensure that your clients receive the best possible service for their settlement including meeting the unique needs of a liability MSA. We stay abreast of the ever-evolving CMS industry changes and offer a range of services including MSA analysis, allocation, and administration so both you and your clients will be confident that Medicare compliance is met.

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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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