When involved in a workers’ compensation claim and covered by Medicare, your primary duty is to protect Medicare's interests as it acts as a secondary payer. This means ensuring that primary payers, like your employer's insurance carrier, fulfill their responsibilities without Medicare covering related medical expenses.
Your Role as a Primary Payer
After your workers' compensation case settles, especially if it includes future medical expenses, you take over the role of the primary payer. This involves properly paying your medical bills using the settlement funds until they are depleted. You also have the option to transfer this responsibility to a professional management company.
Guidelines for Medicare Set Aside (MSA) Funds
When settling with a Medicare Set Aside, you need to follow these CMS guidelines:
- Usage Restrictions: MSA funds can only be used for Medicare-covered treatments related to your injury.
- Account Requirements: Funds must be kept in a separate, interest-bearing bank account.
- Record Keeping: Maintain copies of all bills and receipts.
- Annual Reporting: Report all expenses to CMS annually and whenever funds are exhausted.
- Cost Compliance: Adhere to state fee schedules or "usual and customary" pricing for treatments and prescriptions.
Detailed Obligations and Resources
The obligations to Medicare continue post-settlement. For more detailed guidance and specifics on handling your Medicare Set Aside, including more complex language and scenarios, refer to the CMS Guidelines and Reference Resources. This ensures full compliance and proper fund management.
Key Resources for Managing Settlement Funds
When you settle a claim, your future benefits are condensed into a single settlement sum paid either as a lump sum, structured annuity, or a combination of both. A structured settlement broker can be an invaluable resource, assisting you in managing these funds effectively, particularly for long-term security.
Role of a Professional Administrator
A reputable professional administrator is essential if your settlement involves a Medicare Set-Aside Account. They can help navigate the complexities of medical and pharmaceutical billing, bill paying, rate negotiating, and resource management. Understanding medical bills and managing them after settlement can be an unfamiliar challenge for many, but professional assistance ensures the process is seamless and compliant.
The Centers for Medicare & Medicaid Services (CMS) recommends having a professional administrator due to the complexity involved in handling these funds responsibly.
Seeking Legal Advice Post-Settlement
If you had legal representation during your settlement, discussing your future plans with your lawyer can provide invaluable insights and recommendations. This conversation can help in planning and securing a productive future.
