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Medicare Benefits, Medicare Set Asides, and MMSEA Updates

During the past few months, the Centers for Medicare and Medicaid Services (CMS) have provided updates to its Benefits, Medicare Set Asides (MSAs) and MMSEA Section 111 User Manual. Learn more about the most recent information, and how it affects you and your risk and claim management efforts.

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U.S. Appeals Court Reaffirms Medicare Advantage Plan Rights

On August 30, 2016, the Appellate Court from the U.S. Southern Florida District provided its opinion about whether a contractual obligation, without a judgment or settlement agreement from a separate proceeding, can satisfy the “demonstrated responsibility” requirement of the private cause of action provided for by the Medicare Secondary Payer (MSP) Act.

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MSA RiskPro, a division of Blackburn Group, Inc., designs and creates Lien Verification and Negotiations, Medicare Set Asides (MSAs), Medicare Set Aside Trusts, Medicare Set Aside Accounts, Claim Management and Claim Settlement Solutions. We are recognized by A.M. Best Company as a Recommended Expert Service Provider in the Insurance, Claim Management and Financial industries.

MSA was founded as a specialized Medicare Set-Aside (MSA) insurance claim settlement solutions professional service and product company to address the needs of Workers Compensation and Liability claims under the Centers for Medicare and Medicaid Service (CMS) requirements according to MMSEA Section 111 (MMSEA 111).

What is a Medicare Set Aside? Under Section 1862 42 U.S.C. §1395y(b)(2) and § 1862(b)(2)(A)(ii) of the Social Security Act, Medicare is not responsible for paying a qualified injured person’s medical expenses when payment “has been made or can reasonably be expected to be made under a workers’ compensation plan, an automobile or liability insurance policy or plan (including a self-insured plan), or under no-fault insurance.” If the medical expenses are disputed in a personal injury situation, the provider, physician, or other supplier may bill Medicare as the primary payer. If the product or service is normally reimbursable under Medicare rules, Medicare may pay the expenses conditionally. Then if there is a subsequent settlement, judgment, award, or other payment, Medicare requires reimbursement of the expenses. For more information about your unique situation, ask our experts!

Blackburn Group, Inc.   RiskPro® is a registered trademark of Blackburn Group, Inc.