What is Needed to Submit a Medicare Set Aside?

Your client has a responsibility to ensure that Medicare’s interests as a secondary payer are protected. And since they are your client, the responsibility extends to you as well. Medicare has strict rules in regards to payment for current and future medical expenses. If those rules, are not adhered to, your client may be forced to pay a large portion of their settlement to repay Medicare or lose their right to future Medicare benefits. Either result could expose you to a malpractice claim. The recommended way to alleviate this potential pitfall is by establishing a Medicare set aside (MSA).

About Medicare Set Asides

A Medicare set aside is an arrangement in which money is taken from your client’s settlement and “set aside” to cover the costs of future medical expenses. It’s important to note that money in an MSA is only to be used for expenses related to the specific injury in which the settlement is related. While you or your client can establish an MSA yourself, due it’s complicated nature and importance, it’s a good idea to contact Synergy Settlement Services, a company that specializes in Medicare set aside administration.

What Do You Need to Establish an MSA?

If you do choose to establish and administer an MSA, there are several items that you will need. These include:

  • No less than two years worth of records of treatment related to the injury.
  • Payment records for that timeframe.
  • Your client’s prescription history
  • A Medicare Set Aside Evaluation Referral form

If you are submitting the MSA to the Centers for Medicare and Medicaid Services (CMS), expect about 30 days for them to return an evaluation. A CMS evaluation, while not required, can be helpful in determining if your MSA allots enough money to cover future medical expenses.

For more information or to schedule a consultation, please submit our contact request form or call (877) 242-0022.

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.

TESTIMONIALS

“Synergy is our guiding light for deferring our contingent legal fees and planning for retirement. The lawyers at Panter Panter & Sampedro, myself included, have been working with them for over ten years using different methods to defer comp and plan for retirement.”

Brett Panter
Panter, Panter & Sampedro

"I don't think I've directly said "thank you" for helping us with Bridgett’s case. We sent the reduced payment to Medicaid and called Bridgett's mom to tell her approximately how much money was going to be left for Bridgett and she broke down over the telephone. Given only $25k of insurance and a $850k medical bill from the hospital she didn't think Bridgett would ever see a penny."

Tom L. Copeland
Jeffrey Meldon & Associates, P.A.

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