Medicare is always secondary payer when the patient has received settlement funds for future medical from a Workers’ Compensation or liability settlement. According to Medicare, a Medicare Set Aside are the most frequently used method of protecting Medicare’s interest and preserving the funds for medical items and treatments related to the patient’s injury. For more information on what your patient can use their MSA on, see: Can I Spend my Medicare Set Aside Money?
Medicare recommends that Medicare beneficiaries:
“Should advise their health care provider about the existence of the MSA. They are also notified that their health care providers should bill them directly, and that they should pay those charges out of the MSA if:
- The treatment or prescription is related to what was claimed or the settlement, judgment, award, or other payment had the effect of releasing AND
- The treatment or prescription is something Medicare would cover
The obligation to protect the Medicare trust funds exists regardless of whether or not there is a formal CMS approved MSA amount. A Medicare beneficiary may or may not have documentation they can provide the physician, provider, or supplier from Medicare approving a Medicare Set-Aside amount.”
Medicare also advises providers to document their records when their patient states they are required to use funds from their settlement funds or Medicare Set Aside to pay for medical items and services related to their injury. Providers should accept payment from the professional administrator managing their Workers’ Compensation Medicare Set Aside (WCMSA) funds and not bill Medicare when a third party is administering the WCMSA funds.