Medicare Set-Aside Review
This is a system initiated by Centers for Medicare and Medicaid Services (CMS) to assure that medical costs associated with a work-related injury are not paid through Medicare. A Workers’ Compensation settlement must include an MSA when: Class 1 – The individual is a Medicare Beneficiary at the time of settlement regardless of the amount of settlement. Class II – The individual is NOT a Medicare Beneficiary at the time of settlement but meets these two (2) requirements: A) The total amount of settlement is over $250,000.00 B) There is a reasonable expectation of Medicare enrollment within thirty (30) months of the settlement date. The role of the Medicare Set-Aside Allocator is identifying projected medical costs through interview of treating physicians, review of medical records and research for standards of care and pricing information, to assure that adequate funding is allocated for Medicare reimbursable services. The cost of any recommended treatment, equipment, or service that is not covered by Medicare is not included in the Set-Aside, but documented separately. The figures must be approved by CMS prior to the settlement and are submitted to CMS by the attorney along with supporting documentation. A certification has been developed for Medicare Set-Aside Allocator. After completing a 32 hour course of study, the candidate is eligible to take the certification examination. AIM currently employs a board eligible Medicare Set-Aside Allocator who is also a Certified Life Care Planner.