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Medicare Set-Asides Arrangements

Medicare Set-Asides Arrangements

Medicare Set-Aside Arrangements are financial agreements which set aside a portion of a patient’s workers’ compensation settlement to pay for future medical services related to the injury or illness. These funds must be depleted before Medicare will pay for services. Medicare Set-Aside Arrangements have been used for years in workers’ compensation cases. The federal government has an extensive set of reporting and monitoring rules in place for those cases.

Medicare Confirmation

Medicare Set-Aside Arrangements require verification that the recipient is entitled to Medicare benefits. We make sure that your benefits are properly documented and represented while your case is being built.

Lien verification and reporting

In cases where a Medicare lien has been imposed, OConnell and Associates researches and verifies its validity. We intercede on your behalf, relieving you of the hassle of talking with lawyers or the health plan’s trained agents and stop-loss carriers.

Our team collects updates about the lien and answers requests made by the carrier. We perform a thorough legal analysis, reviewing all plan documentation, including the IRS form 5500, and then assess the plan’s legal position. Finally, we negotiate the lien with your health plan provider and/or their vendor, obtaining an ultimate resolution and Final Release.

Medicare Set-Aside Arrangements Allocations

Medicare Set-Aside Arrangements Allocations are detailed reports. They determine one’s future medical care and include what Medicare accepts and covers and what they do not accept and cover.

Medicare Set-Aside Arrangements are determined on a case-by-case basis.

Submission to Center for Medicare & Medicaid Services

Medicare Set-Aside guidelines are constantly being adjusted by the U.S. Centers for Medicare & Medicaid Services. The October 2018 revision of the Workers’ Compensation Medicare Set-Aside Arrangement Reference Guide, published by the U.S. Department of Health and Human Resources and Center for Medicare & Medicaid Services has 129 pages.

We verify that you are receiving the greatest benefit and that your information gets submitted by their current guidelines. Delays get bypassed as we submit the required forms and supporting documents.

Funding/Administration of the Medicare Set-Aside Arrangements

Compliance with Medicare Set-Aside Arrangements can become complicated in a short time. OConnell and Associates ensures that your case stays compliant so that you can recover from your injury or illness without the hassles of dealing with these complications.

Medicare Set-Aside Arrangements administration includes handling communications with Medicare. We protect your benefits and follow their reporting guidelines. Payments are made in a timely and accurate manner in compliance with the Medicare Set-Aside Arrangements.

We negotiate with providers to save money for the account. As part of of the Medicare Set-Aside Arrangements, we coordinate benefits with your other health benefit policies. We obtain authorizations for new injury-related prescriptions and delivery and training on new medical equipment, such as wheelchairs, beds, and other devices.

Medicare Set-Aside Arrangement administration can also provide assistance in other areas. It can help arrange disabled access accommodations during travel, coordinate tax considerations with you and/or your accountant, and assist with the estate planning aspects of the funds, and more.

Type of Cases We Can Help With

  • Workers Compensation
  • Personal Injury

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