RFC ADMINISTRATORS, INC

Hoke S. Wilder Jr.

Margaret D. “Mickey” Wilder

RFC ADMINISTRATORS, INC

MEDICARE SET ASIDES (MSA’S)

History– Under Medicare Secondary Payer Law, Medicare Set Asides were established to insure Medicare does not pay for services which could reasonably be expected to be paid through no fault insurance, liability insurance, self insured or workers’ compensation

RFC ADMINISTRATORS, INC

WHEN IS AN MSA APPROPRIATE??

- Beneficiary is Medicare eligible

- Within 30 months of Medicare eligibility

- Total Settlement is greater than $250,000.00

RFC ADMINISTRATORS, INCReview by Centers for Medicare

and Medicaid Services

- Required if settlement is greater than $25,000.00

- Determines whether Medicare’s Interest considered

- Specifically reviews MSA Allocation Report for future medical and prescription drug projections… Are they adequate??

- CMS Response…either agree or change projections

- Serves as a blue print for administration

RFC ADMINISTRATORS, INC

MSA ADMINISTRATION -May be professionally or self administered

-May be funded via Lump Sum or via an Annuity - May be administered for life or for a shorter period of time

RFC ADMINISTRATORS, INC

REQUIREMENTS

- Must be placed in a FDIC insured, interestbearing account, separate from all other funds

- Funds may only be used to pay for medical or prescription drug requirements which are related to the injury AND would normally be covered by Medicare

- The fund may be temporarily or permanently exhausted and if so, Medicare becomes primary payer

RFC ADMINISTRATORS, INCREQUIREMENTS CONTINUED

Payment is made using appropriate fee scheduleState fee schedule- workers’ comp

Physician’s Fee Reference- Personal injury & liability cases

CMS requires annual accounting of fund

CMS also requires administrator to maintain

Date of Service Diagnosis

Procedure Payment information

RFC ADMINISTRATORS, INC

ADMINISTRATOR DUTIES

- Establish the account

- Personally contact beneficiary and medical providers

- Provide bill review and repricing according to appropriate fee schedule

- Insure fiduciary requirements are met

- Insure interest rates are maximized and bank charges are minimized

RFC ADMINISTRATORS, INC

ADMINISTRATOR DUTIES CONTINUED

- Coordinate prescription drug programs according to approved MSA… CPS, our alliance partner plays a vital role.

- Maintain documentation and submit reports to CMS as required

- Develop and maintain close relationships with financial institutions and alliance partners

- Be accessible!!! beneficiary attorneys providers

RFC ADMINISTRATORS, INC

MSA ISSUES- MSA funds may not be adequate

- Lack of understandingSettling partybeneficiarymedical providers

- Transitioning from MSA to Medicare and back to MSA

- Maintaining communication with all concerned beneficiary, financial institution, medical providers, alliance partners

- Providing personal service.

RFC ADMINISTRATORS, INC

QUESTIONS????