After settling a case for a Medicare beneficiary client, the next task will be administering their Medicare Set Aside (MSA) account. Your client may choose to self-administer their MSA, which is perfectly legal because The Centers for Medicare and Medicaid Services’ (CMS) guidelines allow for self-administration or professional administration. The guidelines are the same regardless of how MSAs are administered, with the exception of some minor reporting and accounting. Although the process can be daunting and a potentially huge liability, many of your clients may choose to go this route.
Challenges for the Client
Self-administration is not a simple undertaking. Your client must understand both the financial and medical administrative requirements to navigate the process successfully. Your client must ensure that the set aside pays the appropriate calculated rate, funds are spent on Medicare expenses and documented appropriately, and injury-related care is not paid for by Medicare until those set-aside funds have been exhausted. If your client does not properly administer their MSA, they could run out of money faster than expected or Medicare may end up denying coverage for their medical benefits.
Assisting Your Client
The loss of your client’s future Medicare benefits is at stake if they are not equipped to successfully self-administer their MSA. As their attorney, you can assist them by educating them on the intricacies of MSAs and self-administration, and provide them with the appropriate tools and resources to increase their chance of success. Additionally, you should evaluate your client to determine if they have the capacity to carry out self-administration. Assess whether they are mentally and physically capable of managing payments and complying with CMS requirements.
Professional Administration is Preferred
If you find that your client is ill-equipped to undertake self-administration, especially one involves multiple lien holders, recommend professional administration. This method is preferred because the assigned trustee has a fiduciary duty and the professional administrator will understand the intricacies of managing MSA funds and reporting them to CMS.
At Synergy Settlement Solutions, our MSA program employs a Medicare Set Aside Trust arrangement. We have extensive experience assisting attorneys and their clients with MSA and settlement needs including Medicare set aside allocations, submissions, and analysis.
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Disclaimer: The information contained in this article is for general educational information only. This information does not constitute legal advice, is not intended to constitute legal advice, nor should it be relied upon as legal advice for your specific factual pattern or situation.