Professional Administration

Professional Administration is a third-party service that helps you manage your future medical funds after a settlement.  When used for Medicare Set Aside (MSA) accounts it may also be called Medicare Set Aside Account Administration, though the service can help with any medical ongoing needs.

What is Professional Administration?

Professional administration services provide access to discounted drug, provider, and medical equipment pricing, technology that provides a hassle-free experience with medical care, and a dedicated team of representatives to answer questions and help you navigate your medical care. The service also protects the injured person’s Medicare benefits in the case of a Medicare Set Aside (MSA).

Savings on Treatment

A professional administrator establishes a dedicated bank account for your medical settlement funds related to your injury. Most administrators provide you with a card that works like a health insurance card. When you show the card at your pharmacy or doctor, the administrator receives the bill, applies discounts, and then pays the bill automatically. You never have to touch a bill, but receive a record of every transaction, the savings and your account balance information.

Valuing the Case With All Variables

Reporting & Medicare Compliance

Don’t deal with the hassle of paperwork! A professional administrator automatically files necessary reporting for Medicare Set Aside (MSA) accounts, protecting your future Medicare benefits. If reporting is not done properly, Medicare benefits can be jeopardized. The service can be used for any medical allocation (MSA or non-MSA medical funds) as the many benefits of the service extend beyond Medicare Set Aside reporting.

Negotiating a Settlement Amount

Resources & Support

A professional administrator has representatives available to speak with you about your journey to wellness. Many are staffed with pharmacists and other medical experts that can provide information and discuss options with you. Additionally, professional administrators usually have available durable medical equipment (DME) experts who can help the injured individual access any needed equipment—all at reduced prices.

Presenting Settlement to State Workers' Compensation Board

Freedom

Each workers’ compensation or liability case has its own unique variables, so there is no one size fits all used to calculate your claim's future value. It’s important to understand what future medical treatment you will need going forward so that you can ensure the settlement funds are adequate to cover future medical care.

Negotiating a Settlement Amount

Is Professional Administration Required?

Medicare “highly recommend[s] that settlement recipients consider the use of a professional administrator for their funds.”

See Workers' Compensation Medicare Set Aside Reference Guide, v.2.9, Sec. 17.1.

While current guidelines from Medicare allow for you to self-administer a Medicare Set Aside, due to the complexities and risk involved, it is clear why Medicare highly recommends the use of a professional administrator.

If the Medicare Set Aside is improperly managed or administered, it could adversely affect your Medicare benefits and severely interrupt and complicate ongoing treatment, as Medicare could refuse to pay for treatments until you can show you used the Medicare Set Aside funds appropriately.

Medicare requires that all Medicare Set Asides be administered following these main six guidelines:

  1. Funds must be held in an interest-bearing account
  2. Use the fund only for treatments related to the injury
  3. Use the fund only for Medicare–covered expenses
  4. Pay according to the appropriate fee schedule
  5. Prepare and submit annual accounting report to Medicare
  6. Maintain line item detail for the duration of eligibility

If you or your attorney does not comply with this complex list of requirements, you risk being denied your benefits by Medicare.

Learn More About Medicare Set Asides

When to Involve a Professional Administrator

Involve a Professional Administrator if any of the following describe you or your current situation:
frustrated
You are frustrated with the pre-settlement medical care you are receiving for you workers’ compensation or liability case; your treatments are being denied
help
You would like to have help with your future medical care
settlement money running out
You are afraid of settling because you are concerned your settlement money will run out
lose benefits
You are worried you won’t manage your money and do not want to risk getting your Medicare benefits taken away
treatment discounts
You are looking for discounts on your medical expenses
helpful team
You would like to have a team of experts to help answer your questions
professional administration

How to Choose a Professional Administrator

Not all administrators are created equal. One single factor should not drive the overall decision on which professional administration company to utilize. The service, tools, and professionalism along with savings provided by the administrator on behalf of the injured party can vary drastically. For more information about choosing a professional administrator please read our blog article - The 7 Factors to Consider When Choosing a Professional Administrator.

When deciding which professional administrator to go with, there are many factors that should be taken into consideration

Savings
Savings provided on medical expenses
Technology
Convenience of technology
Cost
Cost of service
Customer Service
Quality of customer service
Security
Security of sensitive information

careguard

Professional Administration Service

CareGuard was created with one goal in mind: making the post-settlement process seamless. We do this through our combination of member support and professional administration services.

CareGuard is the first fully automated solution for professional administration which gives the member 24/7 insight into their spending and savings trends. Our team is experienced working with settlements that are both structured into annuities or paid out in a lump sum. We also manage funds for both Medicare Set Asides and other medical allocations.

careguard card
  • savings

    Extending Medicare Set Aside Funds: Through Ametros’ discount networks you may potentially save an estimated 62% on provider visits and an estimated 28% on your prescriptions. Our team reviews every bill for possible savings, in efforts to make your funds last longer.*

  • treatment

    Freedom to Treat: Members can see any doctor or provider, without Utilization Review.

  • support

    Support: 24/7 access to our team of Care Advocates.

  • technology

    Technology: A state-of-the-art online portal where members can review the status and total savings of their CareGuard Medicare Set Aside Account.

  • reporting

    Reporting: With CareGuard, all reporting is handled and members are compliant with Medicare guidelines.

Self-Administration

Without Ametros

Self-Administration Tool

amethyst

Professional Administration

careguard

Bank Account Funds are held in your personal bank account Connects to your own personal bank account Ametros establishes separate bank account in your name per Medicare guidelines
Savings You may pay full price for medications and treatments An average annual savings of 21% on all medical expenses* On average, members save 62% on provider bills, and 28% on all other medical expenses*
Record Keeping All medical receipts must be filed and stored by you Purchases made are automatically recorded in the online portal, or can be recorded by you in the portal Purchases made with the CareGuard card are automatically recorded in the online portal
Reporting Reports need to be completed according to Medicare guidelines in order to protect your benefits Expense reports can be downloaded or sent to Medicare in one click Worry free, fully managed automatic reporting
Support Support consultations available Dedicated support team to answer questions as they arise
Telehealth Access to Telehealth from the portal
Mobile App CareGuard mobile app for easy access to your card information and expenses wherever you are
Get Our Free Starter Packet! Sign Up Now Contact Us
Self Administration

Without Ametros

Bank Account

Funds are held in your personal bank account

Savings

You pay full price for medications and treatments

Record Keeping

All medical receipts must be filed and stored by you

Reporting

Reports need to be completed according to CMS guidelines

Support

Telehealth

Mobile App

Get Our Free Starter Packet!
Self-Administration Tool

amethyst

Bank Account

Amethyst connects to your personal debit account

Savings

An average annual savings of 21% on all medical expenses

Record Keeping

Purchases made with the Amethyst Card are automatically recorded in the online portal

Reporting

Expense reports can be downloaded or sent to Medicare in one click

Support

Support consultations available

Telehealth

Mobile App

Sign Up Now
Professional Administration

careguard

Bank Account

Ametros establishes a separate bank account in your name per CMS guidelines

Savings

On average, members save 62% on provider bills, and 28% on all other medical expenses

Record Keeping

Purchases made with the CareGuard card are automatically recorded in the online portal

Reporting

Worry free, fully managed automatic reporting

Support

Dedicated support team to answer questions as they arise

Telehealth

Access to Telehealth from the portal

Mobile App

CareGuard mobile app for easy access to your card information and expenses wherever you are
Contact Us

*Disclaimer: Any potential discounts or savings for medical treatment, including but not limited to, prescription drugs, durable medical equipment and/or healthcare items and services, are not guaranteed. Ametros has made no warranties, promises, representations or guarantees whatsoever about potential cost savings or the level of potential discounts obtained on any item, service or prescription payment. There are no assurances that prior successes or past results as to cost savings will be applicable to a Member on any of Ametros’ platforms. For additional information, please see our Terms & Conditions Page.

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