A Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) is a financial agreement that allocates a portion of a workers’ compensation settlement to pay for future medical services related to the workers’ compensation injury, illness, or disease. These funds must be depleted before Medicare will pay for treatment related to the workers’ compensation injury, illness, or disease.
All parties in a workers’ compensation case have responsibilities under the Medicare Secondary Payer (MSP) laws to protect Medicare’s interests when resolving cases that include future medical expenses. The recommended method to protect Medicare’s interests is a Workers’ Compensation Medicare Set-Aside Arrangement. The amount of each WCMSA is determined individually, based on a review of the claimant’s medical records and future treatment recommendations.
While there are no statutory or regulatory provisions requiring that a WCMSA proposal be submitted to CMS for review, submission of a WCMSA proposal is a recommended process. CMS will review new WCMSA proposals that meet the following criteria:
- The claimant is a Medicare beneficiary and the total settlement amount is greater than $25,000.00; or
- The claimant has a reasonable expectation of Medicare enrollment within 30 months of the settlement date and the anticipated total settlement amount for future medical expenses and disability/lost wages over the life or duration of the settlement agreement is expected to be greater than $250,000.00
I have many years of experience with the preparation and submission of Medicare Set-Aside proposals. As an attorney and registered nurse, I can prepare them quickly, efficiently, and cost-effectively. If you would like more information about my flat rate for the preparation of Medicare Set-Aside Arrangements, please contact my office.