When a Zero-Dollar Medicare Set Aside Isn’t Enough

Read Time:2 Minute, 42 Second

At times, when settling a disputed or denied claim, parties to the settlement opt to obtain a zero-dollar Medicare Set Aside (MSA) Allocation. A zero-dollar MSA simply means that a thorough narrative report, based on the medical/ legal facts of the claim, is presented to Medicare that explains there is no future liability involving the primary payer and therefore no Medicare Secondary Payer exposure as Medicare becomes primary, not secondary to the non-group health (NGHP) claim, post settlement.

Care Bridge International uniquely offers the MSAPro (a Professional MSA for CMS Submission, review, and approval) and an Analytic-Powered MSA that is based upon the machine learning of our company’s copyrighted, actuary endorsed, Analytic-Powered Claims Database©, including over 16 million bodily injury claims, nationally.

Care Bridge International’s Analytic-Powered MSA offers an alternative for parties who choose non-submission of a MSA to CMS paired with a post settlement support service or custodian to ensure a compliant settlement that demonstrates Medicare protection through the proper spend of the MSA Account. The Analytic-Powered MSA is often used for claims involving Medicare beneficiaries when the total settlement value is less than the CMS threshold for review and approval (Medicare will not review the MSA) or, as in this case example, when there is an immediate need to understand the MSA exposure, and the parties cannot wait weeks for an MSA calculation from a conventional MSA vendor.

A recent example of how these two reports, a zero-dollar MSAPro and an Analytic-Powered MSA, were leveraged in a settlement are presented in this case study.


An insurance carrier’s representing defense attorney requested both a zero-dollar MSA for a totally denied claim and an Analytic Powered MSA, in preparation for a Hearing the following day. Clearly, the need was urgent!

A zero-dollar MSAPro was quickly provided reflecting the carriers’ denial of liability for the claim based upon the following legal defenses:

1) No insurance coverage

2) Statute of limitations

3) False and inadequate medical history, and

4) A lack of substantial industrial causation

The legal facts were detailed in a zero-dollar MSA narrative report. In addition, an Analytic-Powered MSA was generated in minutes totaling $43,536.24, which detailed the risk of reasonable costs, in the event that legal defenses for the claim did not prevail.

Our client was able to know immediately any conditional payment owed to Medicare, any risk of medical exposure, depending upon the settlement outcome, and our client held a zero-dollar MSA prepared for CMS submission, for a full and final compliant settlement under the Medicare Secondary Payer Act, for a claim involving a Medicare beneficiary.

Interested in learning more?

Our consultative, customer journey begins with you.

We place your needs front and center to create a Medicare Compliance program that removes the friction of protecting Medicare and aligns with your companies’ best practices and goals.

CONTACT US to request a Referral, a Demo or a Consultation and follow us on LinkedIn for Blog content and additional sneak peeks into our research, methodology and case studies.

Call Toll Free: 888-434-9326 Ext 101

or EMAIL Bob Schmidt, our Chief Client Officer at Bob@CareBridgeInc.com