Workers’ Compensation

WorkerWorkers’ Compensation Medicare Set Asides (WCMSA)

In situations where Workers’ Compensation benefits are fully commuted as a result of a settlement, Medicare does not have to pay for future related medical care that it otherwise would normally pay for.

CMS believes that a Medicare Set Aside is the best method to protect its future exposure.

Medicare has published quite a few policy memorandum on items that need to be considered when protect its future exposure in a Workers’ Compensation matter and additional memorandum on the development of a WCMSA including when Medicare will review and WCMSA and how to administer and fund a WCMSA.  The CMS policy memorandum listed below detail the following topics related to WCMSAs:

  • No Medicare Payments for a Claimant’s Work-Related Injury or Disease until the WCMSA has been Exhausted  (Ref:  7/23/01 Memo)
  • No Compromise of Future Medical Expenses (Ref: 7/11/05 Memo Q11)
  • No Waivers of Specific Services Related to a WC Case (Ref: 4/21/03 Memo Q18)
  • WC Claims Not Covered in the Settlement (Ref:  4/21/03 Memo Q16)
  • Loss of Medicare Entitlement after CMS Approval of a WCMSA (Ref. 7/11/05 Memo Q9)
  • Effect of WCMSA on Medicaid Eligibility (Ref: 7/11/05 Memo Q13)
  • Use of WC Settlement Funds Prior to Medicare Entitlement (Ref: 7/11/05 Memo Q3)
  • WCMSAs in Cases Where There are Both a WC Claim and a Third Party Liability Claim (Ref: 4/21/03 Memo Q19)
  • Review of a WCMSA
  • Administering a WCMSA
  • Funding a WCMSA
Shapiro SolutionsThe Shapiro Solution
  • Upon submission of our intake form we will prepare a WCMSA Allocation report.
  • By request we will communicate with the treating physicians regarding recommended care.
  • If the case meets CMS’ review criteria (WC is fully commuted and the client is either on Medicare and the claims settled for more than $25,000 or the client has the reasonable possibility of going on Medicare within 30 months and the claim settled for more than $250,000) we will submit the MSA to Medicare for their review.
  • We will educate the client in regards to administering and funding the MSA.
  • We will have the client sign a release stating they have been advised to set aside funds.

To start the process download our intake packet