Managing a Workers' Compensation MSA After Settlement
What happens to a Medicare Set-Aside after settlement?
Settlement is not the end of the Medicare Set-Aside (MSA) conversation. If a workers' compensation settlement includes funds for future care related to the injury, someone must manage those funds and keep records of how they are used. Medicare beneficiaries may self-administer a CMS-approved Workers' Compensation MSA or choose professional administration. The choice affects the day-to-day work after settlement.
The Centers for Medicare & Medicaid Services (CMS) explains that MSA funds are intended for future medical services and prescription drugs related to the settled work injury that Medicare would otherwise cover. Using the funds for unrelated expenses can create problems when Medicare is asked to pay for injury-related care later. The details of a particular account depend on the settlement and applicable CMS guidance.
What self-administration involves
A person who self-administers handles the account and its records. CMS's self-administration guidance describes setting up the account, tracking deposits and withdrawals, paying appropriate injury-related expenses, keeping transaction records, and submitting annual attestations. The CMS Self-Administration Toolkit explains those steps in more detail.
Self-administration gives the beneficiary direct responsibility for the account. It also requires time and attention, especially when there are ongoing prescriptions, several providers, or questions about whether an item is payable from the MSA.
What professional administration can do
With professional administration, a service provider helps manage the account under its agreement with the beneficiary. Services may include bill processing, expense tracking, reporting, and help interpreting account activity. The exact services and fees depend on the administrator's terms, so the settlement team and beneficiary should understand what is included before choosing an option.
Case Management Solutions can coordinate both professional administration and self-administration services for its MSA clients, with a vision of making healthcare easy for injured individuals to manage their post-settlement funding.
Questions worth resolving before settlement
- Who will explain the MSA amount and its permitted use to the beneficiary?
- Who will receive and pay injury-related medical bills after settlement?
- How will prescriptions, provider changes, and disputed charges be handled?
- Who will keep records and submit required attestations?
- If an administrator is chosen, what services and costs are in its agreement?
These questions belong in settlement planning, not as an afterthought. The right choice depends on the beneficiary's needs, the complexity of future care, and the terms of the settlement. A qualified settlement or compliance professional should review the specific arrangement.
Planning a settlement with future medical care? Ask a Case Management Solutions expert how post-settlement support fits the claim, or explore Medicare Compliance. More answers are in our FAQ.