Many Medicare Set-Asides (MSAs) are not reviewed or approved by Medicare because they fall below the thresholds for review. In some cases, even substantial MSAs are not submitted for review by the parties involved in the settlement. Importantly, the process of review and approval by Medicare is entirely voluntary. If the amount Set-Aside is reasonable and deemed adequate by Medicare, and accurate reporting is conducted, Medicare will assume the role of the primary payer once the MSA funds are depleted.
Understanding Medicare Set-Aside Review
Why Some MSAs Are Not Reviewed: Some MSAs don't undergo Medicare's review due to their falling under the specified minimum necessary thresholds. This happens often in cases where smaller sums are expected to cover the entirety of future medical costs.
Voluntary Submission for Approval: Submission of an MSA for Medicare's review is voluntary. It depends on the parties involved in the settlement to decide whether to seek approval for larger MSAs.
When Does Medicare Become the Primary Payer?
Medicare steps in as the primary payer once the MSA funds are exhausted, provided that the Set-Aside was considered reasonable. It's crucial that all reporting connected to the MSA should be detailed and precise to ensure there are no issues with Medicare taking over.
Final Details: Understanding the Process
For more detailed information on Medicare Set-Asides, including guidance and considerations, you might refer to authoritative resources such as the WCMSA Reference Guide. This guide details the processes involved and various scenarios related to MSAs.
