Medicare typically acts as a secondary payer when a patient has settlement funds designated for future medical expenses through Workers’ Compensation or liability settlements. A Medicare Set Aside (MSA) is a common method to safeguard Medicare’s interests by preserving funds specifically for medical treatments and items related to the patient’s injury.
Responsibilities of Medicare Beneficiaries
Medicare beneficiaries are advised to inform their healthcare providers about their MSA. Providers should issue bills directly to the beneficiary, who should then utilize the MSA funds if:
- The treatment or prescription is related to the claimed injury or was covered by the settlement, judgment, award, or other payment.
- The treatment or prescription is typically covered by Medicare.
Provider Obligations
Providers are encouraged to document instances where patients indicate the necessity of using their settlement or MSA funds for medical services relating to their injury. Importantly, providers should accept payments directly from the professional administrator managing the Workers’ Compensation Medicare Set Aside (WCMSA) funds when applicable and refrain from billing Medicare if a third party administers the WCMSA funds.
Additional Considerations
The obligation to protect Medicare trust funds exists irrespective of whether there is a formally approved MSA amount by CMS. Beneficiaries may not always have documentation from Medicare approving the MSA amount for the physician or provider.
Source: Accepting Payment from Patients with a Medicare Set-Aside Arrangement
