Are Medicare Set-Aside Allocations Changing in 2018? Part 1

If you work in personal injury law, then you probably stay on top of Medicare news. The last thing you want is to be faced with penalties if your client neglects their Medicare Set-Aside allocation. Certain aspects of MSAs have changed due to some noteworthy 2017 decisions. As we begin a new year, familiarizing yourself with these changes is a critical step in protecting yourself professionally.

In Part 1 of this two-part series, we will cover the Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide and how it affects you and your clients. In Part 2, we will discuss the potential new set-aside processes for Liability Medicare Set-Asides (LMSAs) and No-Fault Medicare Set-Asides (NFMSA), and whether they will come to fruition.

July 2017 Changes to WCMSA

As you may already know, the WCMSA Reference Guide (which can be downloaded in its entirety at this link) underwent some significant changes last summer when the Centers for Medicare & Medicaid Services (CMS) provided new clarifications of its current policies.

In addition to the clarifications, the guide also outlines how the criteria for submitting a WCMSA re-review is now more generous. The July 31, 2017 implementation of this extended criteria opened the door for submitters to request a re-review in the event that CMS has presented them with an amount but the settlement has not yet transpired. Of course, this only pertains to cases in which the medical care on which the proposed amount was based has been significantly altered.

Some states require Utilization Review processes to justify the amounts proposed by WCMSA. The revised version of the guide sheds light on these situations as well.

Navigating Medicare Set-Aside allocations can be burdensome, not to mention that CMS routinely updates the fine print. As you know, failure to comply with the provisions can land you and your client in hot water. Many trial attorneys prefer sticking to what they do best and leaving the hassle in our capable hands.

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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Synergy’s team makes it easy to deal with all of the issues we hate at the end of the case. Dealing with Medicare, ERISA liens, keeping eligibility intact for Medicaid and complicated planning for the client’s recovery. The experts we work with regularly at Synergy do a great job of making sure I am protected as are my clients.

J. Clancey Bounds
Bounds Law Group

"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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