Injured Workers Who Are Going to Self-Administer Their Medicare Set Aside Need This Guide

On October 9, 2019 the Center for Medicare and Medicaid Services issued the Medicare Set-Aside Self Administration Toolkit.  Although I feel like I’m condemning myself to an eternity in a very bad place for encouraging such a huge consumption of paper, EVERY injured worker who is going to self-administer a workers’ compensation claim approved by the Center for Medicare and Medicaid Services (“CMS”) should get a copy of this.  Maybe print out a card with the link on it and save some trees?

The toolkit describes the self-administration process, from setting up the initial bank account to the exhaustion of funds; explains who the injured worker will work with to manage the MCWSA account; discusses the two types of WCMSA accounts; and covers some other questions that might arise for injured workers trying to deal with this often confusing process.

There are two options for the administration of an MSA: self-administration or professionally administered by a third party.  If the account is to be self-administered, the injured worker needs to submit an annual accounting to Medicare, including a summary of transactions and status of the account, along with receipts and cancelled checks.  He or she also needs to keep a record of those expenditures, because all of the funds in the MSA must be used up before Medicare will begin paying for any claim related medical expenses.  Lastly, the injured worker needs to understand how, upon the injured worker’s death, any unused funds will be paid to his or her estate.

There are also companies which, for a fee, will administer the injured worker’s MSA account for them.  For some injured workers, who lack the ability to effectively administer the MSA account, professional administration may provide avenue to settlement.  The MSA administration companies will review medical bills, and in some cases  negotiate with providers regarding billing; handle record keeping for MSA  expenditures; fulfill the reporting requirements and annual report submission to Medicare.

This administration guide is meant for Medicare Set Asides that have been submitted to and approved by CMS.  Injured workers who do not submit their MSA should not submit an annual attestation.  For more about the Medicare Set-Aside process, you can see New Guide Clarifies Employers’ Liability in Medicare Set-Aside Arrangements; Dealing With Medicare And Medicaid Liens When Settling A Workers’ Compensation Claim; Medicare Set-Aside Facts and Fiction; and Medicare Set-Aside Facts and Fiction-Part II.  You can always feel free to contact me with any questions as well.  Please also think about being kind to the environment and circulating the toolkit electronically, it will ease my conscience a bit.

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