History of Medicare Set Aside
In 1981 the Medicare Secondary Payer (MSP) statute established that Medicare was to be a secondary payer behind the responsible parties for worker's compensation claims.
In July 2001, Medicare implemented a new tracking system that has begun investigating whether it has paid for services that should have been paid by the insurance companies, self insured's, or third party administrators.
Medicare can make a claim against the employer, insurance company, self insured or third party administrator if it is determined that Medicare has paid for services that were not its responsibility, including double damages.
In July 2001, the Centers for Medicare and Medicaid Services (CMS) declared that monies for future medical care and expenses needed to be placed in Medicare Set Aside accounts for certain worker's compensation settlements. Failure to comply may result in CMS refusing Medicare coverage for all future medical treatments related to their injury or illness. This can be a serious liability issue.
On December 30, 2005 CMS released a Memorandum about Medicare Part D. Beginning January 1, 2006, Medicare began its Part D prescription drug coverage as a result of the implementation of the Medicare Modernization Act of 2003 (MMA). Please see CMS memo dated 12/30/2005 for further details.
When is an MSA Required?
****Please note as of July 11, 2005 CMS revised its work review threshold from $10K to $25K. If your settlement amount is over $25K then a CMS submission will be required.
MMSEA Section III (Mandatory Reporting)
From the time that the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA) was introduced, this federal requirement generated widespread uncertainty and concern. KRS MSA has partnered with Fluent Systems a National Data Base Company to assist our client’s with a seamless solution for mandatory reporting.
While there is no one solution, most clients have made the strategic decision to develop their own internal capabilities for MMSEA Section 111 Reporting. We offer a bridge to internal capability by partnering with experts in this area to assist you in developing your internal structure.
We do not promise that we will “handle everything” in exchange for an exclusive contract, but offer you a solution so that you can decide what’s in your company’s best interest.
For current updates on Mandatory reporting please click here.
For more information about a Mandatory Solution please contact Fluent Systems at Phone 1-866-430-5858 or at sales@fluentsystems.net or support@fluentsystems.net
Medicare Secondary Payer Mandatory Reporting
For additional information and a PDF version of the information please click here.
