Medicare Set Aside

Medicare Set Aside

Gulf Coast MSA division can help you with the settlement process and keep your costs down, while maintaining the highest quality work product. Doctor?? future treatment plans, when unclear, will be clarified at no additional cost by sending a letter to the treating physician. Doing this makes our reports more accurate than the average report and less likely to be turned down by CMS (Centers for Medicare and Medicaid Services) when submitted. There is no substitute for QUALITY!

Gulf Coast MSA Services Provides you with:

All MSCC Certified staff completing your files
Personalized service with the MSCC certified person who completed your report
Quick turnaround time

Benefits of an MSA allocation

A proper MSA should be a tool for both the insurance company and the attorney
You will have a comprehensive medical evaluation and breakdown of each treating physician broken down by specialty
The cost projections will correlate directly with the medical report
You will always be given both the Medicare and Non-Medicare costs not just the Medicare costs


In 1981 the Medicare Secondary Payer (MSP) statute established that Medicare was to be a secondary payer behind the responsible parties for workers??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 workers 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.
What constitutes reasonable expectation?
Claims with settlements in excess of $250,000
Expected acceptance by Medicare is within 30 months of settlement
Worker receiving SSDI at the time of settlement
Worker 62.5 years of age at the time of settlement
Worker has end stage renal disease but does not qualify for Medicare
Worker applied for SSDI and was initially denied, but anticipates appealing the decision
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Centers for Medicare & Medicaid Services
National Alliance of Medicare Set-Aside Professionals
The Florida Bar

Gulf Coast Rehabilitation Services, Inc. is the only MSA service provider listed on The Florida Bar
National Archives and Records Administration

(Limitations on Medicare Payment for Services Covered Under Workers' Compensation)


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