Medicare Secondary Payer
Medicare is now enforcing a 1981 federal statute that requires a portion of any settlement be put into a separate interest bearing account to pay for future medical expenditures that may be related to an injry. This statute is referred to as Medicare Secondary Payer Statute (MSP).
Medicare Set-Aside is similar to a life care plan but only lists anticipated future medical costs for services, equipment, supplies, and prescription drugs typically covered by Medicare.
It is of utmost importance that you understand your responsibilities when settling a case that involves a Medicare beneficiary, or someone who will be eligible for Medicare (e.g., SSDI beneficiary).
Northeast Life Care Planning can assist you with evaluating the need for a Medicare Set-Aside, review an existing Medicare Set-Aside/Conditional Payment Summary for accuracy, or draft and submit a Medicare Set-Aside to the Centers for Medicare and Medicaid Services for approval.
The provisions of the MSP may be found at 42 U.S.C. § 1395y(b).
Medicare Secondary Payer Services Include:
Obtaining necessary releases
Determining Social Security and Medicare beneficiary status
Obtaining a Rated Age and calculating life expectancy based on the most recent National Vital Statistics Report and the appropriate United States Life Tables
Initiating a Medicare lien/conditional payment search
Projecting future Medicare covered care
Providing recommendations for structured settlement: initial, annual and periodic payment amounts if appropriate
Submission of the Medicare Set-Aside Allocation to Center for Medicare & Medicaid Services (CMS) for review (optional)
Workers' compensation and liability cases
RN-BC, CCM, CRRN, CNLCP®, LNCC, MSCC