Transcript RFC ADMINISTRATORS, INC

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??
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Beneficiary is Medicare eligible
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Within 30 months of Medicare eligibility
-
Total Settlement is greater than $250,000.00
RFC ADMINISTRATORS, INC
Review 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, interest
bearing 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, INC
REQUIREMENTS CONTINUED
Payment is made using appropriate fee schedule
State 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
Procedure
Diagnosis
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 understanding
Settling party
beneficiary
medical 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????