What is an MSA and why is it important?

An MSA is the consideration of Medicare’s interest in the settlement of the medical portion of a workers’ compensation and liability claims. Considering the current need for a Medicare Set-Aside (MSA) arrangement in all workers’ compensation claims is not an option. It’s mandated by CMS (Center for Medicare Services) per Federal Legislation.

The federal law is intended to protect Medicare’s interests in settling workers’ compensation cases involving future medical expenses that might have an impact on Medicare payments to the claimant. Medicare has specific guidelines relative to protecting its interest and based upon those guidelines there is a responsibility for an MSA. There is no statute of limitations on when Medicare can go back and review a claim, therefore ignorance of the law or process is not a defense.

The consequences for failure to abide by the regulations can be severe for all parties involved including—the claimant, the employer, the insurer, both defense and plaintiff attorneys, and Third Party Administrators. Consequences can be extremely harsh and include fines, other penalties, and legal exposure across numerous fronts. CMS, which administers the program is unconditionally serious about ensuring compliance with MSA regulations.

CMS, which administers the program is unconditionally serious about ensuring compliance with MSA regulations. So is Cambridge. With the number and magnitude of the claims we manage that have MSA implications, the potential risk and consequences of non-compliance for our clients and our company are simply too great to require anything other than absolute adherence to the letter of the law.

 When is an MSA required?

Simply put, there is no more room for interpretation. Within the guidelines it is mandatory that an analysis takes place so that an allocation can be completed.

Here are the CMS guidelines:

• MSA allocations are required on all WC cases where the claimant is Medicare eligible.
• CMS approval is required for all cases $25,000 and above which involve a claimant who is currently a Medicare recipient.
• CMS approval is mandatory for all cases $250,000 and over where the claimant is reasonably likely to be a Medicare recipient within 30 months.

Here are the questions to ask to determine if your settlement requires an MSA:

• Do you know if the claimant is currently a Medicare recipient?
• Is there a reasonable expectation that the claimant will be a Medicare recipient within 30 months and is the settlement $250,000 or greater?
• Has the claimant applied for SSDI (Social Security Disability Income)?
• If applied and denied, is there an appeal?
• Is the claimant 62 1⁄2 years old or older?
• Is the claimant in ESRD (End Stage Renal Disease)?

The complexity of the processes, the stringency of the law and the consequences for non-compliance can make an alliance with Cambridge Galaher an extremely critical enhancement in worker’s compensation settlement negotiations.

 What are the advantages?

• Capping future known and unknown medical exposure.
• Savings of legal expenses through expedient settlement and closure of a claim.
• Significant cost savings to the client employing a structured settlement in conjunction with the Medicare Set-Aside account
• Potential to maintain a reversionary interest on the Medical settlement through the use of cash refund annuities and Medicare Set-Aside Reversionary trust.

 What are Cambridge Galaher MSA Services?

The Cambridge Galaher MSA services offered include:

• Training programs in the identification of Medicare Set-Aside consideration.
• Updates in new Medicare guidelines.
• Review of files, including the gathering of information necessary to provide a written analysis.
• Medicare lien search.
• Securing of age ratings.
• Written analysis of Medicare exposure.
• Submission of written proposal to local Medicare office for approval.
• Assistance in establishing custodial accounts where appropriate.
• Structured settlement proposals for cost analysis of Medicare Set-Aside analysis.
• Assistance in the preparation of life care plans where necessary.

 What is the fee schedule?

Analysis: $1,250 *This charge is billed after the analysis is complete.

Analysis with CMS Approval: $3,000

Re-assess Analysis: $750

Disputed Cases: $150/hour

 How do I refer an MSA?

The following instructions will make the referral process simple and efficient as Cambridge Galaher Medicare Set- Aside Services realizes and respects the busy schedule you have in the administration of your workers’ compensation claims.

• Identify the file as a Medicare Set-Aside candidate. (For clarification, see ‘When Do I Refer an MSA?’)
• Print and fill out the referral form and attach it to the front of your file. Complete the referral form with as much information as you can.
• Print a payment history to include indemnity, medical & prescription drug payments.
• Print out all medical records.
• Print out the original accident report.
• Print out any disputes or contraverted issues.
• If there are volumes to your claim file, please be sure each volume is included in the referral.
• Mail the referral forms and file to:
  
  Dennis Murnick, AVP
  Cambridge Galaher
  175 W. Jackson Blvd. Suite 1000
  Chicago, IL 60604
  312.381.8317
  

 MSA referral form

MSA Referral Form - Online Submission Form