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Understanding Medicare Set Aside Allocations

It is widely known that Medicare is a complex system of payment for medical costs. However, when a person has accident injuries and receives a settlement to cover medical costs, navigating the system becomes even more intricate. The portion of the settlement for medical costs must be “set aside” in an account strictly for medical care expenses such as:

  • Medication costs
  • Diagnostic tests
  • Appointment with a treating physician
  • Surgeries
  • Medical equipment
  • Future prescriptions

That portion becomes known as the Medicare Set Aside Allocation (MSA). The amount of which the Centers for Medicare and Medicaid Services (CMS) determines. The requisite amount will vary, because of the nature of the injury, industry standards for medical expenses that correlate to various injuries, and the duration of treatment or rehabilitation.

The CMS governs the MSA process and mandates strict federal reporting and record-keeping rules. Prior approval for payment of bills is essential. Receipts must demonstrate funds in the account were only for treatments, medications or procedures Medicare covers.

When the funds in a personal injury case or workers’ compensation matter are no longer available and the requisite record keeping and reporting are made, Medicare payments will commence. Medicare will only cover medical costs upon proper completion of the entire process.

Our Multifaceted Approach Can Mitigate High Costs Associated With MSAs

Workers’ compensation claims, third-party claims and personal injury lawsuits can be costly to your business. At Poerio & Walter, Inc., our attorneys and claim audit professionals can ensure your measure of responsibility for these claims is fair and just. We provide innovative legal representation as well as thorough auditing to protect your company’s long-term viability.

We also represent insurance companies and employers throughout the nation in cases where the Medicare Secondary Payer (MSP) Act is relevant due to a claimant’s existing Social Security entitlement or age. We network with the Blackburn Group Inc. to provide comprehensive pre- and post-settlement Medicare set aside services.

Call To Learn How We Can Help Your Business Avoid Excessive Loss

Our attorneys have extensive experience helping businesses navigate successfully through challenging personal injury claims and workers’ compensation matters. Get the personalized attention your business needs by calling us at 412-246-0506 or 717-724-0331 today to discuss your legal options. Reach us online by completing our convenient form.