Medicare Set-aside (MSA)
First Managed Care Option offers complete Medicare Set-Aside Allocation services (MSA). Our MSA program is prepared by Medicare Set-Aside Certified Consultants. Allocations are developed following thorough review and evaluation of injury related medical costs normally covered by Medicare. The Center for Medicare and Medicaid Services (CMS) will only review and approve MSAs that meet the following criteria:
1) In which the injured individual is currently eligible for Medicare- and the settlement amount exceeds $25,000; or
2) If settlement value is over $250,000 (inclusive of indemnity, attorney fees and costs) AND the injured individual is reasonably expected to become entitled to Medicare within 30 months (e.g. the injured individual is currently receiving Social Security Disability benefits).
Once an MSA referral is received by First Managed Care Option it is organized, sorted, scanned and assigned to a MSA Certified Consultant.
The consultant conducts a comprehensive file review, completes the MSA allocation report, and then forwards to a Quality Assurance Manager.
The Quality Assurance Manager scrutinizes the report for accuracy and finalizes. If submission is requested, the Submission Coordinator collects any additional information needed to complete the file for review and approval by CMS (Centers for Medicare & Medicaid Services).
Complete submission file is electronically forwarded to MSPRC (Medicare Secondary Payer Recovery Contractor), where it is downloaded and forwarded either to COBC (Coordination of Benefits Contractor) or WCRC (Workers Compensation Review Center).
The WCRC determination is sent to the CMS Regional Office where the approval letter is generated by the contractor and sent back to First Managed Care Option. First MCO then forwards the approval letter back to our client.
For more information please contact our team of specialists.