Liability Medicare Set Aside

Liability Q&A

Q: Does a liability Medicare Set Aside need to be completed?

A: The same should be considered, (as CMS/Medicare acknowledges the LMSA as a way to protect their interests, as required by Law, in the settlement), if the attorney/carrier collects a settlement for claimant/plaintiff’s injuries under a policy of liability, workers’ compensation and/or no fault insurance and the claimant/plaintiff is a Medicare beneficiary OR is in the “waiting period” for Medicare benefits, as defined by CMS/Medicare’s “Rules” (See Question 2 above for “waiting period” definition), AND the claimant requires future medical treatment for monitoring for the claim injuries. If the claimant/plaintiff’s treating physician will document in writing that no future medical treatment is required, a Medicare Set Aside MAY not be required, per CMS/Medicare’ Rules. Failure to protect CMS/Medicare’s interests in the settlement could jeopardize the claimant/plaintiff’s right to future Medicare coverage for payment of medical bills for treatment of the claim injuries.  Please call MSA Advocates, Inc. for more information BEFORE making this decision to protect all parties.

Q: Can you get a liability “approval” of the Medicare Set Aside from CMS/Medicare?

A: Although CMS/Medicare does not have strict rules/guidelines yet for the liability process; they will still issue an acknowledgment/approval letter confirming their interest has been protected. MSA Advocates strongly suggests an acknowledgment letter is obtained from CMS/Medicare when the Medicare Set Aside is completed.

Q: What happens if I do not complete the Medicare Set Aside for Liability or the Workers’ Compensation claim?

A: If a Medicare Set Aside and written approval/acknowledgment is not completed to protect CMS/Medicare’s interest when it meets CMS/Medicare’s criteria outlined above and in the user guide; then CMS/Medicare has the right (under the Medicare Secondary Payers Act) to recover up to the claimant/plaintiff’s full settlement amount for reimbursement for any conditional payments that CMS/Medicare may make for the future medical treatment of the claim injuries. In addition, keep in mind that CMS/Medicare may deny payment for any future medical treatment for the claim injuries until such time as the claimant can prove that an “approved/acknowledged” Medicare Set Aside has been exhausted or the claim settlement proceeds have been exhausted by payment of medical treatment for the claim injuries.

Q: If there are an employer’s liability claim and a workers’ compensation claim for the same date of loss AND the injury sites are the same for both claims, do the settling parties need to do two Medicare Set Asides if the Medicare Secondary Payer (MSP) Compliance is used to protect Medicare’s interests?

A: No, two Medicare Set Asides are not required. Please call MSA Advocates, Inc. for assistance to be sure that this process is done correctly to protect all parties.

If you should have any questions with regard to the above questions/answers, please call our office and discuss with our knowledgeable staff at 315-472-7965.