Injured parties managing Medicare Set-Asides (MSAs) must adhere to certain rules:
- Use MSA funds exclusively for Medicare-covered treatments related to the injury.
- Maintain funds in a separate, interest-bearing bank account.
- Keep and organize all related bills and receipts.
- Report expenditures to CMS annually or when funds are depleted.
Key Rules for MSA Administration
Adhering to MSA administration regulations is crucial. Here’s a breakdown of important points to remember:
- Medicare-Covered Expenses: The primary rule is that MSA funds can only be used for expenses that Medicare covers, directly pertaining to the injury. This helps ensure continued Medicare coverage when MSA funds deplete.
- Dedicated Bank Account: MSA funds should be stored in a separate, interest-bearing account to prevent commingling with other funds and simplify accounting.
- Record Keeping: Maintaining accurate records is essential. This includes:
- Copies of all bills and receipts.
- Detailed reports of every expense funded by the MSA.
These records must be submitted to the Centers for Medicare and Medicaid Services (CMS) in an annual attestation.
Reporting and Compliance
- Annual Reporting to CMS Regular reporting is mandatory to prove that MSA funds are used correctly. Failing to do so could lead to Medicare denial of injury-related treatments.
- Depletion and Exhaustion Forms In cases where MSA funds are depleted:
- File a temporary depletion form for future annuity payments.
- Submit a permanent exhaustion form if funds are permanently exhausted.
Professional Administration
CMS highly recommends using professional administrators, like Ametros, to ensure proper management and reporting of MSA accounts. This can mitigate risks related to compliance and ensures government reports are accurate.
Further Details and Resources
For comprehensive guidance, refer to CMS' WCMSA Reference Guide and Self Administration Toolkit. These resources offer in-depth information on navigating MSA administration, ensuring compliance, and safeguarding your Medicare benefits.
