MSA Administration

Professional Administration of MSA Accounts

Medicare has very specific and complex rules for administering Medicare Set-Aside Accounts. If your clients do not spend the funds in their MSA Accounts according to Medicare’s rules then Medicare will deny payment of their injury related care until they deposit the misspent funds back into the MSA Account and properly expend the funds.

The most unfortunate part of this process is that your clients will not learn that they made mistakes administering their MSA Account until all the funds in the Account are expended and Medicare denies payment of their bills. The denials will often be years after settlement and it will be highly unlikely that your client will have the money to refund the MSA Account.

Professional Administration avoids this precarious situation. A Professional Administrator will ensure that all medical bills are paid according to Medicare’s guidelines and that all reporting guidelines are met. In fact, CMS recommends that all MSA Accounts have a Professional Administrator in section 17.1 of the Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide v2.7:

Ask yourself these questions:

• Are your clients able to re-price their medications according to the Average Wholesale Price (AWP) as reported in the RedBook?
• Are your clients able to research a treatment code to determine if Medicare covers that treatment code for their diagnoses?
• Are your clients able to determine if their medications are being prescribed for the usage indicated by the FDA? Or whether the medications are prescribed “off-label”?
• Are your clients able to keep all receipts and documents to prove that all MSA funds were properly spent?
• Are your clients able to keep an accurate accounting and comply with Medicare’s reporting requirements?

If you answered “no” to any of these questions, your clients need Professional Administration.