rfc administrators, inc hoke s. wilder jr. margaret d. “mickey” wilder
TRANSCRIPT
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.