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Medicare Set-Aside


The amount of a Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) is determined on a case-by-case basis, and we take an aggressive approach to forecasting future costs, ensuring a solution that is both cost effective and gives adequate consideration to Medicare’s interests. CCSI is unique among our competitors, as we provide internal and legal specialists. Allocation reports are prepared by a Medicare Set-Aside Certified Consultant (MSCC) with over 18 years of experience with workers’ compensation claims.

How it Works

All parties in a workers' compensation (WC) case have significant responsibilities under the Medicare Secondary Payer (MSP) laws to protect Medicare's interests when resolving WC cases that include future medical expenses.

The recommended method to protect Medicare's interests is a Workers' Compensation Medicare Set-aside Arrangement (WCMSA), which allocates a portion of the WC settlement for future medical expenses.

The amount of the set aside is determined on a case-by-case basis and should be reviewed by Centers for Medicare & Medicaid Services (CMS), when appropriate. Once the CMS determined set aside amount is exhausted and accurately accounted for to CMS, Medicare will agree to pay primary for future Medicare covered expenses related to the workers' compensation injury.

The CCSI Advantage

The advantages to utilizing CCSI for your Medicare Set-Aside services are several. Allocation reports are prepared by a Medicare Set-Aside Certified Consultant (MSCC) with over 18 years of experience in the workers' compensation claims field. CCSI uses a premium medical cost containment software that facilitates cost effective pricing of future medical costs.

Also, CCSI provides internal legal and medical specialists, unique to the industry. CCSI takes an aggressive approach to forecasting future costs which encourages a cost effective settlement with adequate consideration of Medicare interests.

Medicare Set-Aside Services (MSA)

  • Medicare Set-Aside (MSA) Allocation Standard Report
  • Medicare Set-Aside (MSA) Allocation Complex/Catastrophic Injury Report
  • CMS submission of MSA
  • MSA evaluation requiring submission of SSA release
  • Medicare conditional payment discovery and negotiation of Medicare liens

When is an MSA recommended?

  • If the claimant is a Medicare beneficiary at the time of the settlement and future medical treatment is recommended or anticipated.
  • If the claimant is receiving SSDI, has applied for SSDI, or has been denied for SSDI but is appealing and future medical treatment is recommended or anticipated.
  • If the claimant is over 62 1/2 years old and future medical treatment is recommended or anticipated.
  • If the claimant has been deemed PTD.

When is CMS approval of an (MSA) recommended?

  • If the claimant is a Medicare beneficiary at the time of the settlement and the settlement amount is greater than $25,000.
  • If the claimant has a reasonable expectation of becoming a Medicare beneficiary within 30 months of the date of the settlement and the settlement is greater than $250,000.