A Medicare set-aside account is established when a settlement for worker’s compensation or liability is sought. As soon as it is decided that MSA can be used, the next thing that has to be determined is how to administer it. As per the general rules, MSA can fund only those future medical costs that fall under the realm of Medicare for medical treatment of the victim’s injuries. Also, the set-aside money has to be kept in an interest-bearing account that is either professionally or self-managed. If it’s a self-administered account, the victim or plaintiff would have to submit a self-attested copy of the form when all the money has been used. However, if the account is in professional hands, the administrator has to create a yearly summary report about the expenses made from the MSA fund and send it to the CMS.
No matter who makes the report, a professional entity or the victim himself, the set-aside fund has to be correctly utilized. It should pay only those expenses that are covered by Medicare. Also, the care has to be taken that Medicare does not start paying the medical costs until the entire fund has been exhausted. Otherwise, it may lead to certain punishment for burdening the Medicare plan.
All this can be taken care based on how the healthcare delivery cost was calculated. Precisely speaking, in case of workers’ compensation, the set-aside amount is arrived at by taking into consideration the compensation fee schedule. If it’s a liability settlement, the standard and customary pricing would matter. That means the administrator has to use money from the account based on the calculation of the allocation of funds. If you need assistance with cost calculation, you can depend on TD&P Consulting healthcare cost analysis or other such professional services for specific guidance.
Generally, the professional service providers create different reports to offer their cost projections for the MSA funds. These can include comprehensive medical cost analysis, non-Medicare cost analysis, a combination of MSA and Non-Medicare Cost analysis, and Medicare cost cover analysis. The format may vary from companies to companies though. Nevertheless, here is a quick look into each kind of this report.
Comprehensive medical cost analysis
This type of report generally covers all future medical expenses without defining Medicare and non-Medicare costs. It is a good option for an individual who is not a Medicare member.
Non-Medicare cost analysis
This projection report contains only those items that are not covered by Medicare. It’s not meant for a person who is not enrolled in Medicare. The costs generally include non-medical expenses, such as gardening, transportation, gym membership, home IV therapy, etc.
MSA and Non-Medicare Cost analysis
In this type of report, both MSA and non-Medicare costs are covered distinctly.
Medicare cost cover analysis
This analysis considers the medical expenses that Medicare had to pay if it was the primary payer for the victim. It doesn’t mention the costs that are not covered by Medicare.
If you hire a reputable agency to work on your behalf on the reports, it may not only create price estimation for your future medical expenses but help you submit the report on time.