Medicare Set-Aside Self-Administration

Why are claimants failing miserably?

Since the establishment of Medicare’s Coordination of Benefits Contractor in 2001, the Workers’ Compensation industry has come into the world of Medicare Set-Aside allocations. Primary payers have been diligently and continuously educated regarding the MSA allocation and most have become proficient on the subject.

Unfortunately, with the intense focus on the Medicare Set-Aside (MSA) allocation, the other aspects of the MSA, such as the methods of funding and of administration, have continued to be given little more than an honorable mention.

The vast majority of Workers’ Compensation (WC) MSAs are still self-administered post-settlement by the claimant. Of all the MSA allocations submitted to The Centers for Medicare and Medicaid Services (CMS) by NuQuest/Bridge Pointe (NQBP) since November 2007, 97% were self-administered. Of those, only 3.2% were provided with the NQBP Self-Adminstration Support Services.

NQBP’s administration specialists speak with hundreds of claimants post-settlement and report that a very small percentage were given the necessasry tools and information at the time of settlement to enable successful self-administraton. In addition, most are given minimal and/or incorrect information regarding how the MSA funds must be utilized and the consequences of inappropriate use of the MSA funds, creating a liability for the insurer or claimant attorney or both.

On a national scale claimants are failing miserably at self-administration and the WC industry is experiencing the fallout. Post-settlement calls to both primary payers and claimant attorneys are increasing as claimants realize they are not equipped to self-administer or because their failure to successfully self-administer has impacted their Medicare benefits. Claimant attorneys are increasingly concerned about malpractice exposure for failing to protect their client’s Medicare benefits in the settlement. Primary payers are concerned about the potential for case reopening and frustrated with the time and effort in fielding calls on closed claims.

These issues and concerns are now impacting current settlement negotiations which in turn have become the catalyst for primary payers and attorneys to seek greater understanding of self-administration requirements and to develop protocols to optimize successful self-administration going forward.

This article will take an in-depth look at the requirements for MSA self-administration, some of the most difficult challenges facing self-administering claimants and finally, some practical steps to optimize successful self administration.

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