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Medicare Set-Aside Allocation Services

Medicare Set-Aside Allocation Services

Physicians Medical Review can be relied upon as your complete Medicare set-aside allocation support organization, providing exceptional, personalized service to the workers’ compensation industry through comprehensive medical allocation services.

If the claimant in your case is a Medicare beneficiary, federal guidelines stipulate that Medicare’s interests must be taken into account before settling a workers’ compensation claim. These guidelines stipulate that settlement dollars must be set aside at the time of settlement, for injury-related medical expenses of the type typically covered by Medicare, in order to prevent the shifting of burden from the primary payer to Medicare. This requirement is met through the development of a Medicare set-aside allocation report.

If you are involved in medical litigation involving a workers’ compensation case and are in need of a comprehensive Medicare set-aside allocation report in order to ensure your client receives proper future medical care, contact Physicians Medical Review.

Medicare Set-Aside Allocation Decision Chart

What Is a Medicare Set-Aside (MSA)?

The amount of settlement dollars that MUST be set aside at the time of settlement, for injury related medical expenses of the type typically covered by Medicare, in order to prevent the shifting of burden from the primary payer to Medicare.

When do you need to consider Medicare’s interest?

Centers for Medicare and Medicaid Services (CMS) requires review/approval of a Medicare set-aside allocation if:

If it remains unclear if your client has Medicare eligibility, contact Physicians Medical Review to determine if a Medicare set-aside allocation is necessary.

What documentation is required for the completion of an MSA?

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The Development of a Medicare Set-Aside Allocation Report

At Physicians Medical Review, the most comprehensive analysis of the present and future medical expenses are carefully analyzed in the development of Medicare set-aside allocation reports. During this in-depth process, an injured party’s eligibility for Medicare benefits are verified, the treatment provider’s recommendations and applicable standards of care are obtained, and a Medicare lien inquiry is conducted. Medicare set-aside allocation reports also include the identification of future medical needs, expenses covered by Medicare in that particular state, and any associated medical costs specific to that geographic region.

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Consequences of Noncompliance with the Statute

The consequences of not complying with the CMS statute when settling a workers’ compensation case can be severe. CMS may deny a claimant future medical care; sue the claimant, his or her attorney, or the insurance carrier; or designate its own allocation. The injured party may also file a malpractice suit against the attorney for failing to obtain a Medicare set-aside report while carrying out the case.

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Review of Medicare Set-Aside Allocations by PMR In-House Physicians

Physicians Medical Review’s attorney clients have the benefit of a complete review of Medicare set-aside documentation by board-certified in-house physicians. After a Medicare set-aside allocation is developed, a PMR in-house physician will carefully analyze all medical aspects of the case to ensure the document meets the highest standards.

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Contact Physicians Medical Review

At Physicians Medical Review, our philosophy and approach create a new and distinctive level of professionalism in the practice of allocation reporting for the workers’ compensation industry. If you are in need of comprehensive medical allocation services, including Medicare set-aside allocation reports, contact Physicians Medical Review today.

David Gold, Attorney At Law
"In claims that PMR's in-house physicians found to be meritorious, their assistance has been invaluable... They have found extremely highly qualified medical experts to support our cases..."

Robert Boyers, Attorney at Law
"I got what I thought was the best testimony, during trial, that I had ever seen..."