Medicare Set-Aside Arrangements

Comprehensive Medical Case Management is an independent, nationwide company offering unparalleled excellence in Medicare Set-Aside arrangements.

Our highly skilled team of experienced certified Medicare Set-Aside Allocation Specialists will ensure your claims are handled professionally and efficiently in an effort to ensure cost savings and expedient case resolution.

CMCM Services

  • CMCM works with Insurance Carriers, Self-Insurers, Insurance Funds and Third Party Administrators.
  • CMCM will collect all of the necessary information and documentation required by CMS.
  • CMCM Medicare Set-Aside Allocation Specialists will review all medical expenses and associated expenses, project future Medicare covered items based on historical data and prepare a comprehensive written report.
  • CMCM will submit all appropriate MSA’s for CMS approval via the Workers’ Compensation Medicare Set-Aside Portal (WCMSAP).

Download General Release Form

Referral Policy

Online referrals managed privately and all data are retrieved by CMCM personnel securely and with complete confidentiality. Be rest assured, your data are safe.

Furthermore, all information remains private, and your email address will never be distributed to any third party under any circumstances.

Thank you for your interest in CMCM.

Download Referral Form

Our MSA Address the Following Needs:

All parties in a Workers’ Compensation (WC) case have significant responsibilities under the Medicare Secondary Payer (MSP) laws to protect Medicare’s interests when resolving WC cases that include future medical expenses.

The recommended method to protect Medicare’s interests is a Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA), which allocates a portion of the WC settlement for future medical expenses.

Submission of a WCMSA proposal to CMS for review and approval is a recommended process. There are no statutory or regulatory provisions requiring that a WCMSA proposal be submitted to CMS for review. However, if an entity chooses to use the WCMSA review process, CMS requests that it comply with the established policies and procedures:

  • The claimant is currently eligible for Medicare and the total settlement value is greater than $25,000*
  • The claimant has a reasonable expectation of Medicare enrollment in 30 months or less and the total settlement is greater than $250,000*

The CMS no longer reviews new WCMSA proposals if the above thresholds are not met. However, CMS wishes to stress that these threshold requirements reflect a CMS operational workload standard. These requirements do not constitute a substantive dollar or “safe harbor” threshold. It remains true that Medicare beneficiaries still must consider Medicare’s interests in all WC cases and ensure that Medicare is the secondary payer to WC in such cases.

*(The total settlement value includes; wages, attorney fees, all future medical expenses, including prescription drugs, repayment of any Medicare conditional payments, payout totals for all annuities to fund medical expenses as well as any previously settled portion of the workers’ compensation claim)

Effective 1/1/06: Medicare’s policy changes include prescription drugs as part of protecting Medicare’s interest. Medicare published a policy memo (4/25/06) clearly stating that the above noted criteria were created strictly as a workload review threshold for Medicare. Any workers’ compensation settlement that sought to limit or close future medicals must adequately consider Medicare’s interest.

Details provided by U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services.
For more information, go to http://www.cms.hhs.gov

Our MSA Procedure

At Comprehensive Medical Case Management, we work with insurance carriers, third-party administrators, those self-insured and attorneys.

Items needed in order to determine Medicare Set-Aside Allocation:

  1. Completed Intake Form
  2. Signed CMS Consent to Release
  3. Signed SSA Consent for Release
  4. General Release
  5. Last 2-3 years of claim payment history
  6. Last 2-3 years of medical records and reports from treating and consulting physicians
  7. Pharmacy summary
  8. Life Care Plan (if available)
  9. Copy of Medicare Card

Items needed in order to obtain CMS approval:

  • Copy of signed Settlement Agreement (proposed), including proper Medicare language
  • Method of administration of MSA allocation (self or professionally)
  • Decision on funding MSA with lump sum or an annuity