CMS Requires Medicare Beneficiary Engagement in the Medicare Set Aside (MSA) Process

Effective April 1, 2020, as stated in the October 2019 release of the CMS Workers Compensation Medicare Set Aside (WCMSA) reference guide, CMS requires a new consent form to be signed by the Medicare Beneficiary when a Medicare Set Aside (MSA) is submitted to CMS for review and approval, whenever future medicals are closed at the time of settlement.

This new CMS action aligns with its mission of patient engagement since the inception of the Affordable Care Act in 2010, by including the beneficiary in the MSA Process. This additional step is designed to eliminate the lack of awareness beneficiaries may have of their personal obligation to protect Medicare through the proper exhaustion of MSA funds, post settlement.

The Medicare Beneficiary, as a stakeholder in the settlement process, is now required to acknowledge not only that the requirements of an MSA are understood, but the beneficiary has an opportunity to review the proposed MSA and agree or disagree with the proposal, prior to CMS submission, through a signed consent. At Care Bridge, we facilitate this consent form when CMS submission for review and approval of an MSA is requested.

It remains to be seen how Medicare Beneficiaries will react to this new responsibility in the Medicare Secondary Payer process. How will a beneficiary decide if the proposed MSA is limited or over-funded? How will the recommended, but voluntary option to submit a MSA for review and approval be explained? How can claims professionals instill confidence in a beneficiary's understanding of their obligation? Care Bridge's non-submit, Analytic-Powered MSA is timely and easily understood, and can be used in tandem with a submit-able MSA to assist in re-assuring the Beneficiary what the data says is a reasonable and probable forecast of care for similar people with the same compensable injury(s), delivering confidence for all parties in this new consent process.

At Care Bridge, our clients receive both a 1) MSA for CMS submission and 2) Analytic-Powered MSA coupled with 3) Professional Administration or Self Administration Support. Our dual MSA approach provides a pathway to settlement that brings clarity in understanding the true medical exposure, at the time of settlement, for all parties.

As CMS continues to round out MSP compliance with pending rule making for MMSEA Section 111 fines and penalties and a new portal for Professional Administrators to upload annual attestation forms, to demonstrate the proper spend of an MSA Account, it is clear that Medicare is more focused than ever on MSP recovery, to protect and sustain our fragile Medicare Trust Fund.

Our experts are prepared and ready to work with you in explaining MSAs to Medicare beneficiaries to promote a successful settlement outcome. To download a copy of the NEW CMS Beneficiary MSA Consent Form visit our Resources page.

For More Information Contact:

Care Bridge International

MSP Compliance Bridge

Compliance. Simplified.


Toll Free: 888-434-9326 Ext. 101

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