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Q&A for Workers’ Compensation Medicare Set-Aside Arrangements

This memorandum supersedes the Part D and Workers’ Compensation Medicare Set-aside Arrangements (WCMSA) memorandum that was published on December 30, 2005.
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Lump-sum Payments

The document discusses lump-sum commutation of future benefits and lump-sum compromise settlement.
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Apportionment of a Lump-Sum Compromise Settlement of a Workers’ Compensation Claim

This document discusses determining amount of compromise settlement considered as a payment for medical expenses and the amount of the Medicare over-payment.
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Exclusions from Coverage and Medicare as Secondary Payer

The full memo discloses the items or services that are specifically excluded from coverage and medicare as secondary payer.
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Ringler Radio: The Benefits of the Professional Administration and Structured Settlement Combination

Learn the benefits of combining a structured settlement with professional administration to help manage the injured party’s medical settlement funds or Medicare Set Aside (MSA) post-settlement.
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The Perfect Pair: Professional Administration and Structured Settlements Whitepaper

To see a real-life case study and the math behind why administration and structures are the best combination, click to download the whitepaper.

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Items and Services Not Covered Under Medicare

This publication provides information on the four categories of items and services not covered under Medicare and applicable exceptions.
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8 Questions from Attorneys About MSA Administration

Download this informative article from our president, Porter Leslie, about Medicare set aside administration featuring experts in the industry.
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Medicare – What Medicare Covers

Find out if your test, item or service is covered. Medicare coverage for many tests, items, and services depends on where you live.
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The Centers for Medicare and Medicaid Services (CMS) Website

The Centers for Medicare and Medicaid Services (CMS) Website
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Accepting Payment from Patients with a Medicare Set-Aside Arrangement

A MSA is a financial arrangement that allocates a portion of a settlement, judgment, award, or other payment to pay for future medical services.
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Medicare & Other Health Benefits: Your Guide to Who Pays First

If you have Medicare and other health coverage, each type of coverage is called a “payer .” When there’s more than one payer, “coordination of benefits” rules decide who pays first.
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Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide

This guide was written to help you understand the process used by the Centers for Medicare & Medicaid Services for approving proposed WCMSA amounts.
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Self-Administration Toolkit for Workers Compensation Medicare Set-Aside Arrangements

If you have decided to self-administer your CMS-approved WCMSA, this Toolkit can help you manage your account appropriately and satisfy Medicare’s interests related to future medical care.
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Sample Submission Checklist for a Workers’ Compensation Medicare

This document, prepared in compliance with § 508 of the Rehabilitation Act of 1973, as amended, is intended to be used as a sample submission or checklist for a sample submission.
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Medicare Secondary Payer Booklet

This booklet provides a general overview of the MSP provisions and outlines your responsibilities.
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Medicare’s Interest: Lump Sum or Structured Settlement

Notwithstanding any other provision of this title, no payment may be made under part A or part B for any expenses incurred for items or services...
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Life Care Plans Prepared by Non-Treating Physicians

Medicare will consider accepting such evaluations if the physician does all of the following...
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Commutation vs. Compromise

One of the distinctions that Medicare regulations and manuals make between compromise and commutation cases is the absence of controversy over whether a WC carrier is liable to make payments.
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WCMSA and Revision of the Low Dollar Threshold for Medicare Beneficiaries

The purpose of this memorandum is to replace Q/A #2 of the July 11, 2005 Memorandum with regard to the Centers for Medicare & Medicaid Services’ low dollar WCMSA threshold for Medicare beneficiaries.
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Pricing Future Prescription Drug Treatment Costs

The purpose of this memorandum is to set forth the Centers for Medicare & Medicaid Services’ (CMS’) procedures regarding the methodology of pricing future prescription drug treatment costs/expenses...
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Pricing of Implantable Devices and Beneficiaries Requesting Termination of a WCMSA Account

This memorandum includes policy regarding the pricing of Implantable Devices and to replaces the policies regarding “Beneficiaries that Request Termination of a WCMSA
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Medicare Set Aside Allocations and Professional Administration

Do you have a case that involves a Medicare Set Aside allocation? Find out how professional administration can help you!
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Life Expectancy in Workers’ Compensation Medicare Set-Asides Proposal

The purpose of this memorandum is to include policy regarding the exclusive use of the Centers for Disease Control (CDC) Table 1 (All American Table) when determining life expectancy...
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Humanity in Worker’s Comp

Ametros' CEO, Marques Torbert, presented at Comp Laude about why practicing humanity in the workers' compensation world is so important.
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Guidance for Submission of a WCMSA Proposal

This memorandum reiterates guidance provided in CMS’ July 23, 2001, July 11, 2005, and April 25, 2006 procedure memoranda regarding CMS’ WCMSA) proposal review thresholds...
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What Happens After Settlement?

Find out how CareGuard can help you manage and track your medical funds after settlement.
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Social Security Program Operations Manual System (POMS)

Click here to navigate to the Social Security's official Program Operations Manual System (POMS)
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US Department of Labor: Division of Longshore and Harbor Workers’ Compensation

Click here to navigate to the official website of the US Department of Labor: Division of Longshore and Harbor Workers' Compensation (DLHWC)
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Medicare Set Asides FAQs

Find out the most common questions about Medicare Set Asides in this downloadable version of Medicare Set Asides FAQs!
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Workers’ Compensation FAQs

Find out the most common questions about Workers' Compensation in this downloadable version of WC FAQs!
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Structured Set-Aside Arrangements

A WC Medicare Set-aside Arrangement can be established as a structured arrangement, where payments are made to the arrangement on a defined schedule to cover expenses projected for future years.
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Prescription Drugs for Medicare Beneficiaries

The purpose of this memorandum is to clarify guidance provided in the Centers for Medicare & Medicaid Services’ April 3, 2009 and July 1, 2009 procedure memoranda regarding prescription drugs...
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Part D and Workers’ Compensation MSA: Questions and Answers

This memorandum includes policy regarding the inclusion of prescription drugs that Medicare will cover as of January 1, 2006, in Workers’ Compensation Medicare Set-aside Arrangements (WCMSAs).
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Workers’ Compensation Frequently Asked Questions (Part 4)

Use of WC Fee Schedule vs. Actual Charges for WC Medicare Set-aside Arrangement? Self-administration of a WC Medicare Set-aside Arrangement?
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Workers’ Compensation Frequently Asked Questions (Part 3)

Clarification of WCMSA Non-beneficiary Threshold.
Low Dollar Threshold for Medicare Beneficiaries.
Use of WC Settlement Funds Prior to Medicare Entitlement...
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Workers’ Compensation Frequently Asked Questions (Part 2)

What are the review thresholds set by the July 23, 2001 All Associate Regional Administrators (ARA) letter concerning WC Commutation of Future Benefits?
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Workers’ Compensation Frequently Asked Questions (Part 1)

When dealing with a WC case, what is "a reasonable expectation" of Medicare enrollment within 30 months?
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Medicaid Tools and Guidance

Click here to navigate to Medicaid's official tools and guidance resources.
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Chapter 3: MSP Provider, Physician, and Supplier Billing Requirements

Limitation on Right to Charge a Beneficiary Where Services Are Covered by a GHP...
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Chapter 2: MSP Provisions

Medicare Secondary Payer Provisions for Working Aged Individuals...
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Chapter 1: MSP Background and Overview

In 1980, Congress enacted the first of a series of provisions that made Medicare the secondary payer to certain additional primary plans.
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Medicare Secondary Payer Recovery Portal User Guide – July 2, 2018 v4.2

The Medicare Secondary Payer Recovery Portal is a secure web-based application that provides the ability to access and update certain Medicare Secondary Payer case-specific information.
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Medicare’s Website

Click here to go to Medicare's official website.
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Medicaid’s Website

Click here to navigate to Medicaid's official website.
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Exclusions from Coverage and Medicare as Secondary Payer

Notwithstanding any other provision of this title, no payment may be made under part A or part B for any expenses incurred for items or services...
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CMS Prescription Drug Set-Aside Guidance for Submitters

Evaluating the sufficiency of the prescription drug component of WCMSAs; required documentation; tapering of drug use; expiration of patents; off-label use; drug utilization review...
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Rated Age Language

This memorandum clarifies Rated Age (RA) language to be included on WCMSA proposals.
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Workers’ Compensation: Commutation of Future Benefits [Update]

This memorandum replaces the policy that was outlined in the answers to questions in the all associate regional administrators (ARA) memorandum.
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Workers’ Compensation Point of Contact List

New Regional Offices Point-of-Contact if your Workers' Compensation Claim is Pending
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Common Questions

We've compiled a list of some of the most common questions we receive and answered them all here!
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When to Involve a Professional Administrator

This guide shows the different triggers and scenarios when professional administration can be beneficial in helping cases move toward settlement!
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Member Testimonials

Hear from real members using CareGuard & Amethyst, learn about their experiences, and find out how our settlement solutions have helped them post-settlement!
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Webinar: Life After Settlement

Led by Melissa Wright & Johnny Meyer, this in-depth webinar shows you what injured parties can expect after settlement.
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Ringler Radio: Simplify Medical Expenses

We've debunked common myths about Medicare Set Aside Professional Administration just for you! Get the facts by downloading our guide now!
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Member Testimonial: Charron

Hear from our member, Charron, as she shares her experience with CareGuard, and how she has benefited from using our professional administration service!
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Welcome to CareGuard

CareGuard is the industry’s first fully-automated, affordable solution to professional administration for medical settlements and Medicare Set-Asides.
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How Do You Pronounce Ametros

Being a Boston based company, we understand that pronunciation is wicked hard. Ah-met-tros? Am-tross? A-metro-s? Find out how to say our company name.
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Common Misconceptions: MSA Administration

We've debunked common myths about Medicare Set Aside Professional Administration just for you! Get the facts by downloading our guide now!
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Ametros Funds Protection

Find out how your funds will be completely secured and what you can expect with our top-notch security platform.
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Benefits Advisory Guide

Learn how our full-service benefits advisory team to help all parties involved understand how to preserve their benefits!
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Step by Step Guide to Professional Administration

Learn all about Professional Administration and its benefits in 7 easy-to-follow steps.
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Workers’ Compensation: Commutation of Future Benefits

This Regional Office letter clarifies CMS' policy concerning how the Regional Offices evaluate and approve WC lump sum settlements to help ensure that Medicare’s interests are properly considered.
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