RN CASE MANAGEMENT
VOCATIONAL/RTW
PREAUTHORIZATION
PEER REVIEW
MEDICAL BILL REVIEW
LIFE CARE PLANNING
CONSULTING


 

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MSA Referral Form

The Medicare Secondary Payer (MSP) statute is having a significant impact on workers' comp and liability claim settlements. Compliance with the statute can be a cumbersome, if not bewildering, process that carries financial and liability risks if not carried out properly.

It is critical to take the MSP statute into consideration when a claim settlement meets certain thresholds. Primary payers in workers' compensation and liability must determine whether a Medicare Set-Aside Arrangement (MSA) is indicated and whether it requires approval by the Centers for Medicare & Medicaid Services (CMS).

Failure to take the right steps can result in stiff penalties, including denial of future Medicare payments to the claimant, and liability and substantial fines for the employer, insurance carrier, and attorneys.

As a long-time trusted resource in workers' comp and liability, Systemedic can help you manage compliance with the Medicare Secondary Payer statute and set up, submit, fund, and administer your MSA. 

Our MSA professionals offer the following services, customized and unbundled, so that you may choose only those specific services you need:

MSA Analysis and Report

• Review records of prior medical care & expenses

• Prepare MSA analysis & cost projections

• Obtain CDC life expectancy or rated age, as appropriate

• Prepare comprehensive MSA report to aid in making a settlement decision, and to be used in any submissions to the CMS.

Submission to CMS

• Collect CMS required documentation

• Prepare report and financial instruments

• Submit to CMS for approval

• Perform lien research with Medicare to determine existence of any conditional payments to claimant

MSA Funding

• Suggest funding options with quotes ( free service )

• Implement a selected funding option proposed

Post-settlement Administration

• Educate claimant regarding Medicare covered expenses and proper procedures

• Reduce to state fee schedule and pay Medicare eligible medical expenses from MSA account

• Provide annual reporting to CMS

• Distribute MSA account balances upon death of claimant

To inquire about Systemedic's MSA services, call 501.227.5553 or 800.822.2680, or email MSA@systemedic.com .

To submit a referral, print and complete the PDF Referral Form below and return to Systemedic by mail, fax or email:

Systemedic MSA Services
10809 Executive Center Drive, STE. 105
Little Rock, AR 72211

Phone: 501-227-5553 or 800.822.2680
Fax: 501.227.8362
Email: MSA@systemedic.com

• MSA Referral Form

The following forms are provided for your convenience, if you need them:

• Social Security Consent Form

• CMS Consent Form

• Request for Medicare & SS Status